Clinical and statistical aspects of gastrointestinal bleeding course in patients with cardiovascular system pathology.
Authors: Trofimov N.V., Kryshen V.P., Barannik S.I., Chukhryenko A.V., Chabanenko G.N., Gayterov A.N.
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We have collected, processed and analyzed the results of treatment of 329 patients with gastrointestinal bleedings in which the course of the underlying disease is aggravated by the pathology of the cardiovascular system, in Communal institution "Dnipro Clinical Emergency Care Association" of Dnipro City Council» in the period for 2017. First, the frequency of background diseases was determined, chronic pathology being 93.4%. Ischemic heart disease (IHD): cardiosclerosis of various origins (post-infarction, diffuse, atherosclerotic), hypertonic disease (HD) - HD-I, HD-II, HD-III are the most common, while acute disorders of cerebral circulation, the state after coronary artery bypass surgery, renal artery bypass, arrhythmias, acute myocardial infarction made up 16 (5%), 1 (0.3%), 3 (1%), 1 (0.3%), respectively. Secondly, the quality of endoscopic hemostasis in case of ulcerative bleeding from the stomach, duodenum, gastroenteroanastomosis, was assessed by Forrest classification, connecting the results with the accompanying pathology of the cardiovascular system. We found that active bleeding F I was determined in 24 people (7.3%), of which F Ia – in 14 (4.3%), F Ib – in 10 (3%). Unstable hemostasis with a high risk of recurrent F II bleeding, was observed in 251 patients, which makes up 76.2%, and F III – in 54 (16.5%). The degree of blood loss was directly influenced by drug – anticoagulants, antiplatelet agents, hypotensive drugs, as well as their combinations, aimed at correcting the rheological properties of blood. Depending on the degree of blood loss, the quality of hemostasis, the general condition of the patient, the treatment tactics for this cohort of patients was determined. 313 patients received conservative treatment, which made up 95.1%. 16 patients were operated. Postoperative mortality is 12,5%. The overall mortality of the above cohort is 10%.