Kolkman J J, Meuwissen S G
Dept. of Gastroenterology, University Hospital Vrije Universiteit, Amsterdam, The Netherlands.
Scand J Gastroenterol Suppl. 1996;218:16-25. doi: 10.3109/00365529609094726.
The majority of patients presenting with acute upper gastrointestinal haemorrhage bleed from peptic diseases erosive gastritis and duodenal or gastric ulcers. Early gastroscopy is essential in order to reach a diagnosis, assess the prognosis, and institute appropriate therapy. In a meta-analysis it was shown that H2-antagonists significantly reduced mortality. However, two large, prospective and placebo-controlled studies with famotidine and omeprazole failed to show reduction of rebleeding or death. The value of endoscopic haemostatic therapy in patients with high-risk peptic ulcers (active bleeding and non-bleeding visible vessel) has been firmly established with 75% decrease in rebleeding and operation rate, and a 40% reduction in mortality. Risk factors for an adverse outcome are: elderly patients, concomitant diseases and large ulcers in the posterior duodenal bulb or on the lesser curvature. The mortality for emergency surgery in upper GI bleeding is still 10-50%. The mortality of elective operations is less than 2%. Some studies have reduced mortality by avoiding emergency surgery through early elective surgery in high-risk patients.
大多数急性上消化道出血患者是因消化性疾病（糜烂性胃炎、十二指肠溃疡或胃溃疡）而出血。早期胃镜检查对于明确诊断、评估预后以及采取恰当治疗至关重要。一项荟萃分析表明，H2拮抗剂可显著降低死亡率。然而，两项关于法莫替丁和奥美拉唑的大型前瞻性安慰剂对照研究未能显示再出血或死亡有所减少。内镜止血治疗对于高危消化性溃疡（活动性出血和非出血性可见血管）患者的价值已得到充分证实，可使再出血率和手术率降低75%，死亡率降低40%。不良结局的危险因素包括：老年患者、合并疾病以及十二指肠球部后壁或胃小弯处的大溃疡。上消化道出血急诊手术的死亡率仍为10% - 50%。择期手术的死亡率低于2%。一些研究通过对高危患者进行早期择期手术避免急诊手术，从而降低了死亡率。
