Peterson W L
J Clin Gastroenterol. 1981;3(Suppl 2):79-84.
Evaluation and initial management of a patient with gastrointestinal (GI) bleeding progresses in stepwise fashion, beginning with assessment of the severity of bleeding. For this, the hematocrit must be considered in conjunction with factors reflecting vascular volume such as blood pressure and heart rate. Resuscitation to maintain tissue oxygenation should than be instituted with intravenous fluids and blood products in amounts appropriate to the severity of hemorrhage. Vital signs are monitored carefully. During resuscitation, attention is directed to determining whether bleeding comes from the upper or lower GI tract. If upper GI bleeding has been proven, gastric lavage is performed through a large-bore orogastric tube using copious quantities of fluid. Empiric therapy for upper GI bleeding, usually aimed at reducing gastric acidity, may be instituted as decisions regarding diagnostic techniques are considered. Endoscopy is a more accurate diagnostic tool than barium x-rays and can be performed in all but massively bleeding patients. There is overwhelming evidence, however, that, at least in patients who cease bleeding during resuscitation, endoscopy does not alter outcome. Since endoscopy is expensive, it should be reserved for selected patients in whom a specific diagnosis will dictate an important change in therapy.
对胃肠道（GI）出血患者的评估和初始处理按逐步方式进行，首先是评估出血的严重程度。为此，必须结合反映血管容量的因素，如血压和心率来考虑血细胞比容。然后应使用与出血严重程度相适应的静脉输液和血液制品进行复苏，以维持组织氧合。密切监测生命体征。在复苏过程中，要注意确定出血是来自上消化道还是下消化道。如果已证实是上消化道出血，则通过大口径鼻胃管进行洗胃，使用大量液体。在考虑诊断技术的决策时，可开始对上消化道出血进行经验性治疗，通常旨在降低胃酸度。与钡剂X线检查相比，内镜检查是一种更准确的诊断工具，除大量出血的患者外均可进行。然而，有压倒性的证据表明，至少在复苏过程中停止出血的患者中，内镜检查不会改变治疗结果。由于内镜检查费用昂贵，应仅用于特定诊断将决定治疗方案发生重要改变的选定患者。
