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Critical Care Focus 9: The Gut - part 7

Chảy máu từ vết loét không còn cách tự nhiên trong ít nhất 80% các bệnh nhân hầu hết đều có một sự phục hồi yên ổn mà không có một can thiệp cụ thể. Tuy nhiên, nhóm phụ của bệnh nhân chảy máu đường tiêu hóa trên người | CRITICAL CARE FOCUS THE GUT increased dramatically and in fact age-standardised mortality has decreased Table 6.1 .2 Bleeding from ulcers ceases spontaneously in at least 80 of patients most of whom have an uneventful recovery without a specific intervention. However the sub-group of patients with upper GI bleeding who do not do well accounts for the overall mortality rate. There are two possible explanations for the unchanging mortality rate. Firstly age and the prevalence of concurrent illness continue to rise among patients presenting with upper GI bleeding. Patients with bleeding usually die not from exsanguination but from decompensation due to other diseases. Secondly until very recently effective non-surgical methods for the control of bleeding from ulcers were not available. Table 6.1 Mortality from upper gastrointestinal bleeding. Reference Mortality Age standardised mortality 2 Jones4 1940-47 9-9 147 Johnston et al.5 1967-8 10-6 122 Rockall et al.2 1993 11-3 100 In 1995 Rockall and colleagues reported a large study to describe the epidemiology of acute upper GI haemorrhage in the UK. Over a four-month period 4 185 cases of acute upper GI haemorrhage were documented.2 The overall incidence of acute upper GI haemorrhage was 103 100 000 adults per year and the incidence rose from 23 100 000 in people less than 30 years old to 485 100 000 in those aged over 75. The incidence in men was double that in women except in elderly patients. Fourteen per cent occurred in in-patients. Overall mortality was 14 11 in emergency admissions and 33 in inpatients . It was concluded that the incidence of acute upper GI haemorrhage increases appreciably with age and that deaths occurred almost exclusively in very old patients or those with severe co-morbidity. A more recent study published in 2000 investigated upper GI haemorrhage which developed while in hospital in patients on ICU.6 Peptic ulcer disease was present in 56 of patients and was the most common source of bleeding