Endoscopic Hemostasis And Opportunities Not Operative Treatment Of Patients With Ulcerative Gastroduodenal Bleedings, Complicated With Hemorrhagic Shock
ENDOSCOPIC HEMOSTASIS AND CAPABILITIES OF
NOT OPERATING TREATMENT ILL WITH ULCEROUS
BY GASTRODUODENAL BLEEDINGS,
COMPLICATED BY A HEMORRHAGIC SHOCK
L.Y. Timen, A.G. Shercinger, S.B. Zhigalova, T.P. Sidorenko, S.V. Stonogin, V.A. Minakov.
Urban hospital № 20, Centre of science of surgery of the Russian academy of medical sciences, Central research and development institute of gastroenterology.
The writers execute a comprehensive programme, bound with study of a problem of treatment of ulcerous gastroduodenal bleedings, complicated by a hemorrhagic shock. It is ground of outcomes of pathomorphologic researches is drawn a conclusion about inexpediency of immediate surgeries in an acute phase of a shock even after stabilisation of hemodynamic parameters and necessity of actuation in a structure of antishock therapy of medical measures, directional on recovery of a general and aboriginal metabolic homeostasis. Therefore, according to the offered concept of an endoscopic hemostasis, at all stages of a hemostasis the aboriginal preventive treatment with usage of materials promoting a metabolic aftertreatment of all locale of a bleeding is executed: 5 % of vitamin C and 5% of glucose. The experimental check of hemostatic, drugs used for an emergency and preventive hemostasis, has demonstrated safety of introduction, and also high reparative, effect most expressed at usage of vitamin C. A state estimation of a homeostasis, gravity of a haemorrhage, degree of operational hazard, forecast of a relapse of a bleeding and survival rates the ill writers effected ground of parameters of an acid-base state, gas composition of a blood and parietal рН of a mucosa of a stomach. The complex treatment 25 patients with ulcerous gastroduodenal bleedings in combination to a hemorrhagic shock is conducted. The primary endoscopic hemostasis reachs for 94,7% ill, including in 7 (36,8 %) supervision - at a proceeding arterial bleeding. The relapses of bleedings are noted in 12% of cases. Seven ill were operated, and 18 patients the conservative treatment is executed. 72% ill are written out from a hospital. Over-all mortality - 22,2%, postoperative - 42,8%, at conservative therapy - 5,5 of %. In monitoring bunch of the patients, emergency operated without a preceding endoscopic hemostasis, lethality - 47,4%.
The writers consider, that the operating treatment of ulcerous gastroduodenal bleedings, complicated by a hemorrhagic shock including at relapses of bleedings, can be appointed only in failures from an endoscopic hemostasis or its defection.
The data on authors:
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Timen Leonid Jakovlevich - lieutenant colonel of medical service, member of American academy of medical sciences, member of American academy of sciences, doctor of branch of endoscopy of supreme category of city hospital N20 of Moscow. Office number 471-33-62.
129327 Moscow, Lenskaya 15, case N 3, branch of endoscopy.
2) Shertsinger Alexander Georgievich - doctor of medical sciences, professor of department of emergency surgery of Russian centre of science of surgery of Russian academy of medical sciences.
129327 Moscow, Lenskaya 15, case N5, surgical branch N1.
3) Zhigalova Svetlana Borisovna - assistant to faculty of surgical illnesses N2 of Moscow medical academy of name I.M.Sechenov on the basis of city hospital N20 of Moscow, candidate of medical sciences. Office number 471-08-98.
129327 Moscow, Lenskaya 15, case N5, surgical branch N3.
4) Sidorenko Tatyana Petrovna - managing branch of endoscopy of city hospital N20 of Moscow, doctor of supreme category. Office number 471-33-62.
129327 Moscow, Lenskaya 15, case N5, branch of endoscopy.
5) Stonogin Sergey Vasil'evich - surgeon of infectious case of Tooshinskaya children's municipal hospital of Moscow, candidate of medical sciences.