Asunto(s)
Quemaduras , Prevención Secundaria/métodos , Infección de Heridas , Investigación Biomédica , Quemaduras/complicaciones , Quemaduras/diagnóstico , Quemaduras/terapia , Humanos , Índices de Gravedad del Trauma , Infección de Heridas/diagnóstico , Infección de Heridas/etiología , Infección de Heridas/prevención & controlRESUMEN
An experience of treatment of 133 patients with severe bums was analyzed. Bleedings from the upper parts of the gastrointestinal tract were diagnosed in 16 patients in different terms since their admission to the hospital. At the moment of carrying out of the endoscopic research all bleedings were considered as taking place. Statistically significant risk factors of the development of gastroduodenal bleedings were considered to be an alcoholic intoxication at the moment of injury and insufficient fluid therapy during the pre-admission stage and young age of the patients. The antisecretory therapy showed that the detection of risk factors in question should be regarded as an indication to the reinforced regime of preventive measures for gastroduodenal injuries.
Asunto(s)
Quemaduras , Famotidina/administración & dosificación , Hemorragia Gastrointestinal , Inhibidores de la Bomba de Protones/administración & dosificación , Choque Traumático , Antiulcerosos/administración & dosificación , Quemaduras/complicaciones , Quemaduras/fisiopatología , Duodeno/irrigación sanguínea , Duodeno/fisiopatología , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/fisiopatología , Hemorragia Gastrointestinal/prevención & control , Humanos , Evaluación de Procesos y Resultados en Atención de Salud , Pronóstico , Medición de Riesgo , Factores de Riesgo , Choque Traumático/etiología , Choque Traumático/fisiopatología , Circulación Esplácnica , Estómago/irrigación sanguínea , Estómago/fisiopatología , Índices de Gravedad del TraumaAsunto(s)
Antifibrinolíticos/administración & dosificación , Úlcera Duodenal , Úlcera Péptica Hemorrágica/tratamiento farmacológico , Úlcera Gástrica , Ácido Tranexámico/administración & dosificación , Anciano , Relación Dosis-Respuesta a Droga , Endoscopía Gastrointestinal , Femenino , Estudios de Seguimiento , Hemoglobinas/metabolismo , Humanos , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Úlcera Péptica Hemorrágica/sangre , Úlcera Péptica Hemorrágica/diagnóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Results of realization of the protocols of organization of the medico-diagnostic care to patients with bleedings from chronic gastric and duodenal ulcers since 2002 have been analyzed. A simplified scale of the assessment of severity of ulcerous bleedings (UB) at admission including 8 criteria is proposed. Protocols of medical strategy for "severe UB" under conditions of the resuscitation unit are discussed. The principles of rendering the medico-diagnostic care for UB allowed stabilization of total lethality among these patients at the level of 3.4-3.7% at operative activity 27%. The possibility to improve results of the treatment of this pathology in future is associated by the authors with the available and high quality elements of conservative treatment.
Asunto(s)
Protocolos Clínicos , Servicios de Diagnóstico/organización & administración , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/cirugía , Úlcera Péptica/diagnóstico , Úlcera Péptica/cirugía , Pautas de la Práctica en Medicina/organización & administración , HumanosRESUMEN
On the basis of the study of 2388 patients with chronic gastric and duodenal ulcers complicated by acute bleeding, the most disputable organizational and tactical issues of ulcer bleeding (UB) treatment are discussed. It is reasonable to divide surgery for UB into urgent, delayed and elective. Indications for different surgeries in UB and basic surgical principles are discussed. Severe blood loss is the main factor of general lethality. Combined conservative therapy must provide correction of posthemorrhagic tissue hypoxia, functional disorders, hemostatic disturbances and immunosuppression. Artificial transmitters of oxygen and infusion of antihypoxants are promising in management of UB. Antisecretory drugs are a necessary component of conservative treatment in UB. Therapeutic endoscopy is important in the treatment of acute UB, but it is not alternative to surgical hemostasis. It may be regarded as a method of temporary hemostasis before delayed for more than 2 hours operation or as a method of final hemostasis in combined conservative treatment, first of all in patients of "surgical risk" group.
Asunto(s)
Úlcera Péptica Hemorrágica/cirugía , Análisis Químico de la Sangre , Tratamiento de Urgencia/métodos , Humanos , Úlcera Péptica Hemorrágica/mortalidad , Complicaciones Posoperatorias/mortalidad , Factores de TiempoAsunto(s)
Neoplasias Gástricas/diagnóstico , Úlcera Gástrica/diagnóstico , Antígenos de Carbohidratos Asociados a Tumores/sangre , Biomarcadores de Tumor/sangre , Antígeno CA-19-9/sangre , Antígeno Carcinoembrionario/sangre , Enfermedad Crónica , Diagnóstico Diferencial , Humanos , Neoplasias Gástricas/inmunología , Neoplasias Gástricas/patología , Úlcera Gástrica/inmunología , ÚlceraRESUMEN
The data presented show that along with acid-peptic aggression an important role in pathogenesis of stress ulceration in the stomach and duodenum belongs to energy and immune deficiency which makes the correction of these alterations necessary. The timely and valuable conservative therapy including histamine H2-receptor blocking agents in addition to antacids and endoscopic electrocoagulation in case of profuse bleeding from stress ulcers allows to obtain hemostasis and healing of the ulcers more than in 90% of cases. When choosing the surgical method of treatment the preference should be given to atraumatic organ-preserving operations.
