Need to clinicians!Master these 4 points to calmly deal with acute digestive tract bleeding!

Acute gastrointestinal bleeding refers to acute bleeding caused by digestive tract (esophageal, stomach, and duodenum) lesions above the Cydine ligament, including venous tension rupture bleeding (Avugib) and non -intravenous tension.It is one of the most common critical illness in emergencies. Once patients lose blood, they are likely to cause shock or even death.The annual incidence of adults is 100/100,000 ~ 180/100,000, and the mortality rate is 2%to 15%.

Clinically, when patients with suspected acute gastrointestinal bleeding are obtained, it is very important to diagnose and treat rapid diagnosis and treatment. This article will combine related literature to sort out the knowledge points of acute digestive bleeding diagnosis and treatment for clinical reference.

Patients with typical vomiting blood, dark stools or blood in the stool are easy to diagnose.The vomiting blood is mostly coffee -like, and even a bright red blood clot.Black stools may appear asphalt -like (sticky and shiny). If the amount of bleeding is large, the feces can be dark red or even bright red. Pay attention to the identification of bleeding with the lower digestive tract.

Gastric juice, vomit or stool submarine blood positive prompts may be bleeding patients.

Patients with typical symptoms such as dizziness, fatigue, and syncope, especially patients with unstable vital signs, pale complexion, and reduced acute hemoglobin, should be alert to the possibility of gastrointestinal bleeding.

Exposure caused by acute blood loss

· Dizziness, palpitations, sweating, fatigue, dry mouth and other symptoms can occur when the amount of bleeding is> 400 mL;

· When the amount of bleeding is> 700 mL, the above symptoms are significant, and syncope, body coldness, pale skin, decreased blood pressure, etc.;

· Park can be generated when the amount of bleeding is> 1000 ml.

The following one of the following should be considered as dangerous and acute gastrointestinal bleeding.

Active bleeding, circulating failure, respiratory failure, conscious disorders, accidental suction or GLASGOW BLATCHFORD Score (GBS) scores> 1 (see Table 1 for details).

Table 1 GBS score

Note: 1 mmhg = 0.133 kPa; GBS is Glasgow Blatchford Score score

Comprehensive clinical manifestations can divide the patient’s danger into 5 layers, namely extremely high risk, high risk, medium risk, low -risk, and extremely low risk. The diagnosis and treatment of the corresponding area according to the degree of danger (see Table 2 for details).

Table 2 The risk of acute digestive tract bleeding

Note: Under the premise of ensuring medical safety, appropriate adjustments are made in accordance with the medical environment and resources of the hospital.*The shock index = heart rate/systolic blood pressure, 0.5 means that the blood capacity is normal; 1 is mild shock, the amount of blood loss is 20%~ 30%; > 1 is moderate shock, the amount of blood loss is 30%~ 40%;The amount of blood loss is 40%to 50%; > 2 is extremely weight shock, and the amount of blood loss is> 50%.GBS scores Glasgow Blatchford Score.1 mmhg = 0.133 kPa

1. Emergency disposal

Conventional measures "OMI", namely oxygen, monitoring, and intravenous.Patients with conscious disorder, respiratory or cyclic failure should pay attention to airway protection to prevent accidental suction.Give oxygen therapy or artificial ventilation if necessary, and start recovery.

The treatment of resuscitation mainly includes the application of capacity resuscitation, blood transfusion and vascular active drugs.Patients with high -risk urgent upper digestive bleeding need to stay in bed.

2. Capacity recovery

The acute digestive bleeding of blood flow dynamics should be a positive capacity recovery, but the specific strategy of recovery currently lacks evidence -based basis.Reference to the recovery concept of trauma bleeding, when the bleeding is not controlled, the restricted liquid resuscitation and allowable hypotension recovery strategies are used. It is recommended to keep the systolic blood pressure at 80 ~ 90 mmHg (1 mmHg = 0.133 kPa).

3. Blood transfusion

A large number of patients with blood loss need to infuse blood products appropriately to ensure tissue oxygen supply and maintain normal coagulation function.In the following situations, blood transfusion should be considered: systolic blood pressure <90 mmHg; heart rate is> 110 times/min; HB <70 g/L; blood cell ratio <25%or blood -loss shock occurs.For acute large amounts of bleeding, a large number of local blood transfusion schemes need to be started immediately for blood transfusion.

It should be individually weighing blood transfusion risks and benefits. Generally, restrictive blood transfusion strategies are generally adopted, and HB target values are recommended for 70 ~ 90 g/L.

4. Drug treatment

(1) acid suppressing drugs

Acute non -venous tension high -digestive tract bleeding often requires acidic treatment.The commonly used acidic drugs include proton pump inhibitors (PPI) and H2 receptor antagonists.PPI is currently the preferred acid suppression drug.The course of gastrointestinal ulcer PPI is 4-8 weeks.Low -risk re -bleeding digestive ulcers (flat and clean at the base) are given oral PPI once a day.

(2) Drugs that reduce door vein pressure

Patients with cirrhosis, chronic liver history, or gate vein hypertension are likely to have a high possibility of venous veins. Such patients often have a large amount of bleeding and have a high mortality rate in the early stage.Therapeutic drugs include supertimein and its analogs (oosotides) and vascular calcium and their analogs (Telicatin).

(3) Hemotherapy

The whole body and partial use of hemaggluting enzymes are used through oral or gastric tubes to use coordinase, Yunnan Baiyao, Sulfur, or Ice.

After emergency response, when the patient’s life signs are stable, a comprehensive assessment should be performed and inferred the cause and part of the hemorrhage to prevent re -bleeding.Most of the acute digestive tract bleeding is acute non -intravenous bleeding. The most common causes include gastric duodenum intestinal digestive ulcers, upper digestive tract tumors, stress ulcers, and acute and chronic upper digestive tract mucosal inflammation.

1. Endoscopy is the first choice for clearing the cause of acute gastrointestinal bleeding

For Anvugib, the guidelines are currently advised to perform endoscopic examinations if there is no taboos within 24 h; patients with continuous instability of blood flow dynamics after active recovery should conduct emergency endoscopic examinations.

Avugib is often large bleeding, blood transfusion and infusion speed are much lower than the hemorrhage rate, and endoscopic examination should be performed within 12 h.

2. Perform the endoscopy while the endoscopy is determined by endoscopy.

For ANVUGIB treatment: gives drug spraying, injection, hemostatic clips and thermal coagulation therapy (laser, microwave, high -frequency electricity, thermal probe, etc.) according to the specific lesion nature.

For AVUGIB treatment: endoscopic first -line therapy includes varicose veins, sclerosis or tissue adhesive injection therapy; clinical studies have proved that endoscopic therapy control effects are similar to that of supertime and their analogs, so active esophagus pipes are therefore active. ThereforeWhen gastric vein bleeding is bleeding, drug therapy or drug combined with endoscopy should be preferred.

When endoscopic taboos or examination negatives still have active bleeding, or drugs and endoscopic treatment of bleeding failure, emergency intervention can be treated.For ANVUGIB patients, the treatment method includes injecting hemorrhage blood vessels in hemorrhage or direct catheter arterial embolism; for AVUGIB patients, drugs and endoscopic hematopoietic failure can be considered after the intra -intraocular permia.

Patients with drugs, endoscopy, and interventional therapy still cannot stop bleeding, and should be treated with surgery.

references

[1] Chinese Medical Association Emergency Doctor Branch, Emergency Medicine Branch of the Chinese Medical Association, Professional Commission of the Army’s Emergency Medicine, etc.: 1-10.

[2] Wang Lijun. New progress of the diagnosis and treatment of acute digestive tract bleeding [J]. Chinese and Western medicine combined emergency magazines, 2021, 28 (1): 125-127.

[3] Li Xue, Dong Yongqi, He Song. The risk grading and clinical application of acute digestive tract bleeding [J]. Modern digestion and intervention diagnosis and treatment, 2022, 27 (2): 229-233.

Turn, typeset 丨 Wang Shenchong

School pair 丨 Feng Xiwen

Review 丨 Xing Chen

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