Schulz F, Hanusch J, Starlinger M, Schiessel R
Wien Klin Wochenschr. 1986 Apr 18;98(8):233-7.
312 of a total of 543 emergency endoscopies were carried out in patients with severe haemorrhage of the upper gastrointestinal tract. This was defined as a haemorrhage of such severity that at least 2 of the following 3 criteria were present: a shock index greater than 1, an erythrocyte count of less than 3 million/mm3, and a transfusion requirement of three or more 500 ml bags of blood. The source of the bleeding was exactly located in 247 endoscopies, and accurate diagnoses were established in 94.4% of the cases examined. The most frequent source of bleeding was oesophageal varices, followed by duodenal ulcers. In 20.2% of these cases, further sources of potential haemorrhage were found in the upper gastrointestinal tract. Endoscopic diagnosis resulted in immediate, specific therapy in 286 cases. Treatment was given within the first 24 hours in every case. 24.7% of our patients had to undergo laparotomy immediately after endoscopy. 30.4% were given H2 receptor inhibitors, and 35.6% underwent endoscopic haemostasis. The mortality rate in these patients was 29.5%. These results indicate that emergency endoscopy is an important aid to decision-making in cases of severe haemorrhage of the upper gastrointestinal tract.
在543例急诊内镜检查中，有312例是针对上消化道严重出血的患者进行的。上消化道严重出血的定义为：出现以下3项标准中的至少2项：休克指数大于1、红细胞计数低于300万/mm³、输血需求达到3袋或更多500ml袋装血液。在247例内镜检查中准确找到了出血源，在所检查的病例中有94.4%得以确诊。最常见的出血源是食管静脉曲张，其次是十二指肠溃疡。在这些病例中，有20.2%在上消化道发现了潜在的其他出血源。内镜诊断使286例患者得到了立即的针对性治疗。所有病例均在最初24小时内进行了治疗。24.7%的患者在内镜检查后立即接受了剖腹手术。30.4%的患者使用了H2受体抑制剂，35.6%的患者接受了内镜止血治疗。这些患者的死亡率为29.5%。这些结果表明，急诊内镜检查对上消化道严重出血病例的决策具有重要帮助。
