骨科手术后并发应激性溃疡大出血

Stress ulcer with bleeding in postoperation of orthopaedics surgery

目的 探讨骨科手术并发应激性溃疡大出血临床诊断与治疗。方法 我院1997年9月-2002年8月收治骨科手术后并发应激性溃疡大出血患者11例,其中男7例,女4例。年龄29岁-78岁,平均56.2岁。严重创伤6例,其中3例合并颅脑外伤;脊柱疾病手术2例;骨关节炎、类风湿性关节炎关节置换手术3例。4例患者合并有高血压,5例患者长期服用激索和非甾体类消炎药物(NSAIDs),3例患者抗凝治疗。临床表现为排柏油样大便,呕血,低血容量休克,贫血。急诊胃镜检查显示胃十二指肠粘膜糜烂,弥散性出血。出血1500ml-4000ml,平均2700ml。结果 输血2000ml-4500ml,平均3300ml。9例患者痊愈,死亡2例。结论 骨科手术并发应激性溃疡大出血是一种严重的并发症,治疗在于有效控制出血,补充血容量,同时注意对重要脏器的保护。对长期服用容易引起胃粘膜损害药物的患者,围手术期应使用抑制胃酸分泌的药物,预防应激性溃疡的发生。

Objective To study the clinical diagnosis and treatment of stress ulcer with bleeding in postoperation of orthopaedics surgery. Methods From September 1997 to August 2002,11 cases, male 7 and female 4, age from 29 to 78, averaged 56.2, underwent stress ulcer with bleeding in the postoperation of Orthopaedics Surgery. Severe trauma in 6 cases (3 cases with brain injury) , Spain diseases in 2 cases, os teoarthritis or rheumarthritis in 3 cases among them. 4 patients suffered hype rtention, 5 cases used non - steroidal anti - inflammatory drugs (NSAIDs) and corticosteroids to relieve the pain in a long term, and 3 cases with anti - coagulants therapy during the perioperative period. There were tarry stool, hematemesis, hypovolemic shock andaneamia among them. Gastroscopy for emergency indicated erosion and bleeding in diffusion of gastroduodenal mucous membrane. The total amount of bleeding from 1500ml - 4000ml,averaged 2700ml in one cases.Results The total number of blood transfusion was from 2000ml - 4500ml, averaged 3300ml in one cases. 9 cases fully recovered from stress ulcer with bleeding, and 2 cases were death. Conclusions Stress ulcer with bleeding was a severe complications in postoperation of orthopaedics surgery. The treatment to stress ulcer with bleeding should be control actively bleeding, support the stability of blood pressure, and prevent progressive organ failure. The surgical intervention should be performed after the failure of conservation treatment. Acid suppressants should be use to the patients who have permanently took drugs which case to damage gastric mucosa during perioperative period.