Storey D W, Bown S G, Swain C P, Salmon P R, Kirkham J S, Northfield T C
N Engl J Med. 1981 Oct 15;305(16):915-6. doi: 10.1056/NEJM198110153051603.
We performed endoscopy within 24 hours of admission in 292 unselected patients admitted to the hospital for acute gastrointestinal hemorrhage. In 132 patients endoscopy revealed peptic ulcers, and in 117 full examination of the crater was possible. Visible vessels were identified in 56 patients (48 per cent); other stigmata of recent bleeding (such as oozing from the ulcer crater) were present in 21 (18 per cent), and no stigmata in 40 (34 per cent). Among the patients with either visible vessels or other stigmata of recent bleeding, 47 were randomly selected to be observed (without treatment) for evidence of further bleeding. Nineteen of 34 patients with visible vessels (56 per cent) had rebleeding, as compared with one of 13 (8 per cent) with other stigmata of recent hemorrhage; no patients with ulcers without visible vessels or other stigmata of recent hemorrhage bled further. We conclude that after bleeding occurs, visible vessels can be identified in a much higher proportion of ulcers than previously reported, and that rebleeding occurs almost exclusively in this type of ulcer, although only half the ulcers with visible vessels do in fact bleed further.
我们对292例因急性胃肠道出血入院的未经挑选的患者在入院24小时内进行了内镜检查。132例患者内镜检查发现有消化性溃疡，其中117例对溃疡灶进行了全面检查。56例患者（48%）发现可见血管；21例（18%）有近期出血的其他征象（如溃疡灶渗血），40例（34%）无出血征象。在有可见血管或近期出血其他征象的患者中，随机选择47例进行观察（不治疗）以寻找进一步出血的证据。34例有可见血管的患者中有19例（56%）再次出血，而13例有近期出血其他征象的患者中有1例（8%）再次出血；无可见血管或近期出血其他征象的溃疡患者均未再次出血。我们得出结论，出血后，可见血管在溃疡中的发现比例比以前报道的要高得多，而且再次出血几乎只发生在这类溃疡中，尽管实际上只有一半有可见血管的溃疡会进一步出血。
