Alekseev A A, Bobrovnikov A E
Vishnevsky National Medical Research Center for Surgery, Moscow, Russia.
Russian Medical Academy for Continuous Professional Education, Moscow, Russia.
Khirurgiia (Mosk). 2020(12):38-45. doi: 10.17116/hirurgia202012138.
To analyze the incidence of erosive and ulcerative lesions of gastrointestinal tract in patients with burns, including those complicated by gastrointestinal bleeding, depending on severity of injury, complications of burn disease and treatment features.
Medical records of 1833 patients were reviewed. We have retrospectively analyzed symptoms of disease and incidence of gastrointestinal bleeding depending on treatment strategy in patients with identified erosive and ulcerative lesions of gastrointestinal tract.
Risk of gastrointestinal erosions and ulcers, including those complicated by gastrointestinal bleeding, correlates with area and depth of burn damage, especially in patients with thermo-inhalation injury and infectious complications of burn disease. Proton pump inhibitors intake in patients with burns of up to 50% of body surface area (BSA) and deep lesions up to 40% of BSA is followed by less incidence of gastrointestinal bleeding compared to H-histamine receptor blockers. At the same time, severe burns of more than 50% of BSA ensure high risk of gastrointestinal bleeding regardless antisecretory therapy.
Endoscopy upon admission is recommended in all patients with burns ≥30% of BSA or deep lesions ≥20% of BSA, as well as severe thermo-inhalation injury. This approach ensures timely diagnosis of gastrointestinal lesions and their adequate treatment.
根据烧伤严重程度、烧伤疾病并发症及治疗特点，分析烧伤患者胃肠道糜烂和溃疡性病变的发生率，包括并发胃肠道出血的情况。
回顾了1833例患者的病历。我们回顾性分析了已确诊胃肠道糜烂和溃疡性病变患者的疾病症状及根据治疗策略得出的胃肠道出血发生率。
胃肠道糜烂和溃疡的风险，包括并发胃肠道出血的情况，与烧伤损伤的面积和深度相关，尤其是在热吸入性损伤和烧伤疾病感染并发症患者中。与H组胺受体阻滞剂相比，体表烧伤面积达50%及以下且深度病变达40%的烧伤患者服用质子泵抑制剂后胃肠道出血发生率较低。同时，体表烧伤面积超过50%的严重烧伤患者，无论采用抗分泌治疗，胃肠道出血风险都很高。
建议对所有体表烧伤面积≥30%或深度病变≥20%的烧伤患者以及严重热吸入性损伤患者入院时进行内镜检查。这种方法可确保及时诊断胃肠道病变并进行适当治疗。
