Duggan J M
Med J Aust. 1986 Mar 3;144(5):247-50. doi: 10.5694/j.1326-5377.1986.tb115886.x.
This report outlines the results of 568 episodes of acute upper gastrointestinal haemorrhage managed in the Gastroenterology Unit of The Royal Newcastle Hospital during 1964-1974. In this Unit a conservative regimen of blood transfusion and surgery was used with the aim of operating immediately on the recurrence of bleeding for patients with chronic gastric ulcers. In comparison with the 523 patients who were bleeding who were treated in other medical units in the same hospital during 1964-1969, the mortality rate was lower for all peptic ulcers (4.9% compared with 10.6%; P less than 0.025) and for gastric ulcers (8.9% compared with 23.1%; P less than 0.01), but differences for duodenal ulcers (3.6% compared with 5.8%) and in the other diagnostic sub-groups were not significant. The results are also compared with those from units that manage all admissions for upper gastrointestinal bleeding at Prince Henry's Hospital, Melbourne (which has an aggressive transfusion and surgical policy), and The Royal North Shore Hospital of Sydney (which has a "standard" approach). In spite of radically different policies, all three gastrointestinal units obtained rather similar results, with the Newcastle mortality rate from bleeding ulcers of 4.9% being the lowest of all. It is suggested that all large hospitals should have haematemesis and melaena units, as they do coronary care units, but that there is no advantage to be gained by a policy of aggressive treatment.
本报告概述了1964年至1974年间在皇家纽卡斯尔医院胃肠病科处理的568例急性上消化道出血病例的结果。在该科室，采用了输血和手术的保守治疗方案，目的是对慢性胃溃疡出血复发的患者立即进行手术。与1964年至1969年期间在同一家医院其他科室接受治疗的523例出血患者相比，所有消化性溃疡（4.9% 对比10.6%；P小于0.025）和胃溃疡（8.9% 对比23.1%；P小于0.01）的死亡率较低，但十二指肠溃疡（3.6% 对比5.8%）及其他诊断亚组的差异不显著。研究结果还与墨尔本亨利王子医院（采用积极的输血和手术策略）以及悉尼皇家北岸医院（采用“标准”方法）处理所有上消化道出血入院病例的科室结果进行了比较。尽管政策截然不同，但所有三个胃肠病科室的结果相当相似，纽卡斯尔医院出血性溃疡的死亡率为4.9%，是所有医院中最低的。建议所有大型医院都应像设立冠心病监护病房一样设立呕血和黑便科室，但积极治疗策略并无优势。
