2012美国消化性溃疡出血处理指南.pptVIP

Management of Patients With Ulcer Bleeding Initial assessment and risk stratification 初始评估与风险分层 Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed (Strong recommendation). 评估血流动力学状态，按需启用复苏措施 2. Blood transfusions should target hemoglobin≥?7 g / dl, with higher hemoglobins targeted in patients with clinical evidence of intravascular volume depletion or comorbidities, such as coronary artery disease (Conditional recommendation). 3. Risk assessment should be performed to stratify patients into higher and lower risk categories and may assist in initial decisions such as timing of endoscopy, time of discharge, and level of care (Conditional recommendation). 4. Discharge from the emergency department without inpatient endoscopy may be considered in patients with urea nitrogen 18.2 mg / dl; hemoglobin ≥?13.0 g / dl for men (12.0 g / dl for women), systolic blood pressure ≥?110 mm Hg; pulse 100 beats / min; and absence of melena, syncope, cardiac failure,and liver disease, as they have 1 % chance of requiring intervention (Conditional recommendation). Pre-endoscopic medical therapy 内镜检查前药物治疗 5. Intravenous infusion of erythromycin (250 mg ~ 30 min before endoscopy) should be considered to improve diagnostic yield and decrease the need for repeat endoscopy. However, erythromycin has not consistently been shown to improve clinical outcomes (Conditional recommendation). 6. Pre-endoscopic intravenous PPI (e.g., 80 mg bolus followed by 8 mg / h infusion) may be considered to decrease the proportion of patients who have higher risk stigmata of hemorrhage at endoscopy and who receive endoscopic therapy. However, PPIs do not improve clinical outcomes such as further bleeding, surgery, or death (Conditional recommendation). 7. If endoscopy will be delayed or cannot be performed, intravenous PPI is recommended to reduce further bleeding (Conditional recommendation). Gastric lavage 洗胃 8. Nasogastric or orogastric lava