Wiboltt K S, Petersson B G
Stanford University Medical Center, Department of Surgery, California 94305.
Eur J Surg. 1994 Jun-Jul;160(6-7):375-9.
To review our results of the treatment of acute upper gastrointestinal bleeding since 1990.
Retrospective study.
District hospital.
226 patients who presented with acute upper gastrointestinal bleeding between January 1990 and April 1992.
Upper gastrointestinal endoscopy and, in 15 cases, emergency laparotomy.
Morbidity and mortality, and the incidence of emergency operations.
There were 5 deaths (4%) and 11 emergency operations (10%) in 1990, compared with one death (1%) and 4 operations (4%) during the subsequent 16 months. Duration of hospital stay was reduced from a mean of 7 days to a mean of 6 days and the amount of blood transfused from a mean of 3.4 units to a mean of 2.4 (p < 0.02) over the same period. 149 patients (66%) were over the age of 65 years, 82 (36%) were taking potentially dangerous drugs, and 129 (57%) had serious coexistent diseases.
We conclude that the natural history of acute upper gastrointestinal bleeding may be changing, and that our "one team" approach comprising immediate resuscitation, urgent endoscopy, emergency operation when indicated, and intensive nursing, is responsible for the improvement in our results over the period of time studied.
回顾我们自1990年以来治疗急性上消化道出血的结果。
回顾性研究。
地区医院。
1990年1月至1992年4月期间出现急性上消化道出血的226例患者。
上消化道内镜检查，15例进行了急诊剖腹手术。
发病率、死亡率及急诊手术发生率。
1990年有5例死亡（4%），11例急诊手术（10%），而在随后的16个月中有1例死亡（1%），4例手术（4%）。同期住院时间从平均7天降至平均6天，输血量从平均3.4单位降至平均2.4单位（p<0.02）。149例患者（66%）年龄超过65岁，82例（36%）正在服用有潜在危险的药物，129例（57%）患有严重的并存疾病。
我们得出结论，急性上消化道出血的自然病程可能正在发生变化，我们的“团队协作”方法，包括立即复苏、紧急内镜检查、必要时进行急诊手术以及强化护理，是我们在研究期间治疗效果改善的原因。
