Lai K C, Hui W M, Wong B C, Ching C K, Lam S K
Department of Medicine, University of Hong Kong.
Gastrointest Endosc. 1997 Jan;45(1):26-30. doi: 10.1016/s0016-5107(97)70299-2.
Low risk of rebleeding has been observed in patients with gastrointestinal bleeding due to peptic ulcer without high-risk stigmata of recent hemorrhage. We aimed to evaluate the safety and acceptability of an aggressive early discharge policy in those patients admitted with upper gastrointestinal bleeding due to duodenal ulcers without high-risk stigmata of recent hemorrhage.
Retrospective analysis was carried out in bleeding ulcer patients less than 60 years of age with stable vital signs and no stigmata or only flat spots on endoscopy. A prospective study was then performed that included only duodenal ulcer patients less than 60 years of age with stable vital signs, no concomitant serious medical illness, and no stigmata of recent hemorrhage. These patients were discharged on the same day that endoscopy was performed.
During a period of 18 months, 72 patients satisfied the criteria in the retrospective study. The mean hospital stay was 1.4 days (range, 1 to 5). There were no episodes of rebleeding nor significant drops in hemoglobin level 2 weeks after discharge (10.8 gm/dL +/- 1.4 vs 11.0 gm/dL +/- 1.5). Seventy-five patients were recruited into the prospective study. None of them had rebleeding nor significant drops in hemoglobin 1 week after discharge (12.1 gm/dL +/- 1.8 vs 11.7 gm/dL +/- 2.5).
We conclude that patients with gastrointestinal bleeding who have clean-based duodenal ulcers and are stable on admission can be safely discharged on the same day as endoscopy.
在因消化性溃疡导致胃肠道出血且无近期出血高危征象的患者中，观察到再出血风险较低。我们旨在评估对因十二指肠溃疡导致上消化道出血且无近期出血高危征象而入院的患者实施积极早期出院政策的安全性和可接受性。
对年龄小于60岁、生命体征稳定、内镜检查无征象或仅有扁平斑的出血性溃疡患者进行回顾性分析。随后进行了一项前瞻性研究，仅纳入年龄小于60岁、生命体征稳定、无合并严重内科疾病且无近期出血征象的十二指肠溃疡患者。这些患者在进行内镜检查的当天出院。
在18个月的期间内，72例患者符合回顾性研究的标准。平均住院时间为1.4天（范围为1至5天）。出院后2周内无再出血事件，血红蛋白水平也无显著下降（10.8 g/dL±1.4 vs 11.0 g/dL±1.5）。75例患者被纳入前瞻性研究。他们在出院后1周内均无再出血，血红蛋白也无显著下降（12.1 g/dL±1.8 vs 11.7 g/dL±2.5）。
我们得出结论，患有基底清洁的十二指肠溃疡且入院时病情稳定的胃肠道出血患者，可在内镜检查当天安全出院。
