ТАКТИКА ЛЕЧЕНИЯ ПАЦИЕНТОВ С ЯЗВЕННЫМИ ГАСТРОДУОДЕНАЛЬНЫМИ КРОВОТЕЧЕНИЯМИ

Abstract

Background. In spite of the achievements of modern gastroenterology the number of patients with ulcerative gastroduodenal bleeding do not tend to decrease. Lethality is still rather high – from 10 to 15%, which reaches 20-45% during the recurrence of bleeding. Endoscopic hemostasis was effective in 96-98% of the patients only. Indications for surgical treatment when endoscopic hemostasis has been performed are still the subject of discussion. Purpose. To analyze data on the results of emergency care and treatment of the patients with gastroduodenal ulcer bleeding in the city specialized bleeding center to optimize therapeutic and diagnostic tactics. Material and methods. The analysis of data on the results of treatment of 981 patients with ulcerative gastroduodenal bleeding. Results. In the clinic, an algorithm for therapeutic and diagnostic measures for effective treatment of the patients has been developed, based on the possibility of carrying out 24-hour endoscopy study, which makes it possible to identify the source of bleeding in the shortest possible time, to determine its character, to assess the stability of hemostasis, and simultaneously perform endoscopic hemostasis (temporary or final). Further therapeutic tactics is based on the complex prediction of gastroduodenal ulcer bleeding recurrence, the automated assessment of the severity of the patient's condition with the definition of the degree of operational risk and the rational replenishment of the circulating blood volume based on a computerized assessment of the transfusion requirement. Conclusions. The application of modern endoscopic methods of bleeding control enabled to reach the final hemostasis in 99.3% of patients with gastroduodenal ulcer bleeding which significantly reduced the number of emergency operations.