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[The causes of recurrent ulcerative gastroduodenal bleeding]
E M Lipnitsky1, A V Alekberzade1, M R Gasanov1
1Department of Surgery, Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow.
Khirurgiia
|April 5, 2017
Summary
Excessive fluid therapy in ulcerative gastroduodenal bleeding may increase recurrent bleeding risk. Reducing infusion volumes and using sedative therapy can improve patient outcomes and tissue oxygenation.
Area of Science:
- Gastroenterology
- Internal Medicine
- Critical Care Medicine
Background:
- Ulcerative gastroduodenal bleeding is a significant clinical challenge.
- Microcirculatory changes play a crucial role in bleeding and patient outcomes.
- Understanding early microcirculatory dynamics is key to optimizing treatment.
Purpose of the Study:
- To investigate microcirculatory alterations within 48 hours of admission for ulcerative gastroduodenal bleeding.
- To correlate these changes with clinical bleeding manifestations.
- To determine the impact of therapeutic interventions on recurrent bleeding.
Main Methods:
- A cohort of 108 patients with ulcerative gastroduodenal bleeding was studied.
- Endoscopic characterization used the J. Forrest classification.
- The Roccal Prognostic Scale assessed recurrence risk.
- Patients were grouped based on the occurrence of recurrent bleeding within 48 hours.
Main Results:
- Early microcirculation changes included blood flow slowing, centralization, and altered oxygenation.
- Pronounced hemodilution, decreased oxygenation, and hypovolemia were observed by day one.
- Patients with recurrent bleeding showed distinct circulatory decentralization and impaired tissue oxygenation, potentially linked to excessive fluid therapy.
Conclusions:
- Infusion therapy for initial gastroduodenal ulcerative bleeding should be conservative.
- Sedative therapy may mitigate central nervous system influences on microcirculation.
- Optimizing fluid management is critical to prevent recurrent bleeding and improve tissue oxygenation.