Bleeding of Nonulcer Origin in Patients with Cardiac Pathology
Keywords:bleeding from ulcers and acute erosions, individually rational tactics
Urgency of an issue. It’s mentioned that ischemia is a disease of old people who has age-related changes of internal organs and vessels, multi-organ failure and atrophy of mucus membrane. Treating this pathology requires using aspirin of a like nature meds that also has negative influence on mucus membrane of digestive tube.
Research objective. To improve the results of treatment of patients with bleeding acute erosions and critical cardiac pathology.
Materials and methods. There were shown the results of working during the period from 1998 to 2011. 1256 patients with bleeding acute erosions and ulcers of the upper digestive tract were treated. Patients with critical pathology of the cardiovascular system were 52.2 %. 23.4 % of patients had an acute bleeding ulcers cause by nonsteroidal anti-inflammatory drugs.
Results and discussions. During the period from 1998 to 2002 there were 460 patients with acute bleeding ulcers. 15 of them (3.3 %) required surgical interventions. 60 % of patients of this group had a relapse of bleeding as a main reason of surgical therapy. The mortality rate was 20 %.
The treatment concept of patients in this category, based on individual-rational tactics, was developed in our hospital. We use an optimal techniques and methods of treatment depending on the clinical symptoms and characteristics of the disease. Treating patients with bleeding demands coordinated actions of surgeons, experts in resuscitation and endoscopists. Conservative therapy was a priority method — the combination of day and night monitoring of therapeutic endoscopy, antisecretory therapy, treatment of leading pathology and the effects of blood loss.
During the period from 2003 to 2011, 789 patients with this pathology were hospitalized. Using developed in our clinics methods of treatment of patients with bleeding acute erosions and ulcers of stomach allowed us to improve the results of treatment. The number of surgical interventions decreased in a half (to 1.4 %). Rational using of endoscopic methods and introduction of endoscopic monitoring allowed to decrease the number of bleeding relapses from 42 to 12.5 %. This has reduced the number of surgical interventions from 66.7 to 16.7 %, and postoperative mortality — from 13.3 to 2.3 %. There were not observed significant growth in total mortality, and mortality in non-operated patients. The total number of rebleeding decreased from 10.9 to 7.7 %.
Every endoscopic operations worsen current destructive changes of mucus membrane. So these operations should be as smoothly as possible and should minimally influence on health. When performing endoscopic hemostasis sometimes it’s difficult to estimate its effectiveness. We try to achieve the decreasing of bleeding intensity. Within 3–4 hours we carry out intensive therapy using blockers of proton pomp in combination with vasoconstrictor drugs (remistip). Correction of internal organs disfunctions is obligatory in our opinion. Controlling endoscopic procedures allows to estimate the effectiveness of treatment and to provide therapeutical manipulations. In case of rebleeding we try to use all possibilities of conservative therapy to prevent surgical interventions.
Conclusions. Developed tactics enables to decrease significantly the number of rebleedings in patients with critical cardiovascular pathology.
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