- 期刊
血管攝影術應用於難以控制的消化道出血－20病例之臨床觀察
Angiography for the Management of Poorly Controlled Gastrointestinal Hemorrhage - 20 Cases Clinical Observation
摘要
Diagnostic and therapeutic angiorgraphy has demonstrated an important role in gastrointestinal hemorrhage. During the past 2 years, we performed angiography in the past 2 years, we performed angiography in the management of 20 patients with uncontrolled gastrointestinal bleeding. Conservative management including medication and treansfusion would not appear to suffice in these patients had been evaluated to have a high operative risk in our series. Ten of the 20 patients had renal dysfunction (creatinine ＞1.7 mg/dl) before angiography. The role of angiography in the managment of patients with renal dysfunction remains controversial because angiography is likely to produce acute renal failure. We performed angiography to stop bleeding in these patients with renal dysfunction because they could die of blood loss. In our 20 cases, bleeding sites were identified in 14 patients. The detection rate was 70%. Thirteen of the 14 with the use of either vasopressin infusion or arterial embolization showed complete cessation of bleeding in 10 patients. Three cases failed to be controlled. One received an operation after a bleeding site was located by angiography. In our study, sepsis with renal failure was the leading cause of mortality (6 cases). Ten patients with pre-existing renal dysfunction had angiography performed and only one showed abrupt elevation of creatinine levels after angiography. He also developed sepsis. Deteroration of renal function was possibly due to angiography or more likely due to sepsis after angiography although 4 of these patients showed cessation of bleeding. Four cases with pre-existing renal dysfunction and without evidence of infection survived after angiographic management. Angiography has become a good tool in the diagnosis and treatment of gastrointestinal bleeding and does not invariably produce acute renal deterioration, even if the patients have pre-existing renal dysfunction and hypovolemia. Preangiographic evalvation and control of infection are very important in patients with gastrointestinal bleeding because the mortality of these patients is high, although their bleeding is controlled.
關鍵字
無資料並列摘要
Diagnostic and therapeutic angiorgraphy has demonstrated an important role in gastrointestinal hemorrhage. During the past 2 years, we performed angiography in the past 2 years, we performed angiography in the management of 20 patients with uncontrolled gastrointestinal bleeding. Conservative management including medication and treansfusion would not appear to suffice in these patients had been evaluated to have a high operative risk in our series. Ten of the 20 patients had renal dysfunction (creatinine ＞1.7 mg/dl) before angiography. The role of angiography in the managment of patients with renal dysfunction remains controversial because angiography is likely to produce acute renal failure. We performed angiography to stop bleeding in these patients with renal dysfunction because they could die of blood loss. In our 20 cases, bleeding sites were identified in 14 patients. The detection rate was 70%. Thirteen of the 14 with the use of either vasopressin infusion or arterial embolization showed complete cessation of bleeding in 10 patients. Three cases failed to be controlled. One received an operation after a bleeding site was located by angiography. In our study, sepsis with renal failure was the leading cause of mortality (6 cases). Ten patients with pre-existing renal dysfunction had angiography performed and only one showed abrupt elevation of creatinine levels after angiography. He also developed sepsis. Deteroration of renal function was possibly due to angiography or more likely due to sepsis after angiography although 4 of these patients showed cessation of bleeding. Four cases with pre-existing renal dysfunction and without evidence of infection survived after angiographic management. Angiography has become a good tool in the diagnosis and treatment of gastrointestinal bleeding and does not invariably produce acute renal deterioration, even if the patients have pre-existing renal dysfunction and hypovolemia. Preangiographic evalvation and control of infection are very important in patients with gastrointestinal bleeding because the mortality of these patients is high, although their bleeding is controlled.
延伸閱讀
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