[Complex intensive care for acute gastroduodenal hemorrhages in patients after operations on the heart and vessels].
The purpose of the study was to define the most effective principles of intensive care for acute gastroduodenal hemorrhages in patients undergoing operations on the heart and vessels. The outcomes of 13,345 operations on the heart and vessels, performed at the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, were analyzed. Gastroduodenal hemorrhages were diagnosed in 114 patients, which amounted to 0.8% of the total number of operated patients. In the vast majority (86.8%) patients, gastroduodenal hemorrhages occurred after surgery under extracorporeal circulation. The results of medical and surgical treatment were analyzed. The medical treatment for gastroduodenal hemorrhages included intensive drug therapy and endoscopic hemostasis. The comprehensive and intensive approach to performing antiulcer therapy (concomitant use of the antisecretory agents: proton pump inhibitors, gastric protectors, and reparative agents) could reduce the incidence of recurrent bleeding and the timing of epithelization of gastrointestinal mucosal defects. Analyzing the results of the treatments has indicated that the efficiency of conservative measures significantly exceeds the beneficial effect of the treatment of gastroduodenal bleedings, including urgent abdominal surgical interventions. Emergency surgical interventions for gastroduodenal hemorrhages in cardiosurgical patients deteriorate the postoperative period and lead to an increase in postoperative morbidity, which determines the expediency of their performance only when conservative measures are ineffective. An algorithm of tactical actions has been developed for gastroduodenal hemorrhages occurring after operations on the heart and vessels.
Iarustovskiĭ
M B
MB
Shipova
E A
EA
D018806:APACHE; D000208:Acute Disease; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods*; D005112:Extracorporeal Circulation / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D010438:Peptic Ulcer Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*