2012美国消化性溃疡出血处理指南ppt课件.pptVIP

20. After successful endoscopic hemostasis, intravenous PPI therapy with 80 mg bolus followed by 8 mg/h continuous infusion for 72 h should be given to patients who have an ulcer with active bleeding, a non-bleeding visible vessel, or an adherent clot (Strong recommendation) . 21. Patients with ulcers that have flat pigmented spots or clean bases can receive standard PPI therapy (e.g., oral PPI once daily) (Strong recommendation). 国家汽车产业政策的相继出台和落实，势必对汽车消费起到了拉动作用；而银行汽车消费信贷的推出和实现，则是汽车消费市场快速成长和发展不可或缺的重要手段。 Management of Patients With Ulcer Bleeding Initial assessment and risk stratification 1. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed (Strong recommendation). 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 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 in