Health Worlds

General measures
The treatment of upper gastrointestinal bleeding, the primary task is to stop the bleeding and control shock, followed by samples taken into account for the causes of bleeding in the comprehensive treatment.
Diet and rest: even the mild upper gastrointestinal bleeding should also pay attention to rest. No vomiting, could eat earlier as appropriate, can eat a diet of milk and then to less slag, hematemesis who moderate bleeding or bleeding esophageal varices should be strict fasting, to be gradually restored after complete cessation of bleeding eating.
In addition to esophageal and gastric varices patients should be 2 to 3 days of fasting, the ulcer patients vomiting blood flow after the cessation of cool juice consumption should be gradually replaced by semi-liquid sauce and soft food. Can eat the soup cool, milk, milk, each about 50 ~ 60ml, gradually increased, became mushy soft food. Consumption can reduce the gastric hunger contractions, and in acid, nutritional supplement, a favorable recovery. Patients with esophageal varices, 2 to 3 days of fasting should.Bleeding of upper gastrointestinal bleeding is a fundamental rescue treatment measures, but not the cause of bleeding treatment before disposal to stop bleeding, and bleeding after the disposal of the cause and prevention of rebleeding. Acute bleeding is more general application of integrated Chinese and Western ideas of two method, and then after the cause for treatment.
(1) General em


ergency bleeding: In addition to fresh whole blood transfusion on outside help to stop bleeding, use the following Western and measures. Such as bleeding Min, An network of blood, vitamin K, on the carboxy benzylamine, tranexamic acid, intravenous drip, slowly push or intramuscular injection.
(2) Fiber Endoscopic hemostasis: an emergency gastroscopy can be found not only determine the site of bleeding lesions, and may stop the bleeding by endoscopy for various emergency measures, the implementation of the endoscopic local bleeding, including:
injection of various drugs on the bleeding site: If 5% of Monteggia spray liquid (Monsells solution), fluid Monteggia's main content is alkaline sulfate, as an astringent, make blood coagulation, embolization of bleeding vessels.
injection sclerotherapy bleeding esophageal varices: use of cod liver oil, such as sodium (sodium morrthuate), Xiaozhiling other hardening agent, hardening of the blood vessel happened to stop bleeding or prevent re-thrombosis and bleeding.
coagulation: mainly used for ulcer bleeding ulcer disease, arterial bleeding is the best indication. Variceal bleeding is not applicable.
laser hemostasis: General Ne laser used (argon) , the blue-green, red surface, easy to absorb, and the penetration force is 0.1mm, reported bleeding rate 80% ~ 96%; CO2 laser can not by musical form gastroscopy import penetration are poor, it is not practical; neodymium, ytterbium aluminum garnet (Nd-YAG) laser penetration, can enter through the 0.3mm thickness, bleeding and strong, but also caused a small perforation of the possible, so applications should be attention.
microwave bleeding: use of microwave surgical device, the electrode through the looking glass into the coagulation of upper gastrointestinal bleeding, the theoretical basis of the body of water positive and negative position to follow the microwave field changes polarity, the polarities of the super- speed change (2450 * 10 (6) times / S), microwave heat (electrolysis heat), bleeding within the organization play a role in blood coagulation has been reported particularly good hemostatic effect.
2. Rescue shock
Placed under intensive care patients, given its record of pulse, blood pressure, urine output and systemic microcirculation (such as facial, hand, foot temperature, etc.), it is best to measure central venous pressure to guide the infusion. Of bleeding in patients with shock and recovery steps are:
testing for cross matching blood type, and 4 units of blood preparation;
infusion to build a smooth channel, in addition to peripheral vein if necessary, with the application of the subclavian vein, jugular vein or the basilic vein catheter for rapid blood transfusion;
bleeding while giving the preliminary measures, such as bleeding sensitivity, blood and other network security;
such as cirrhosis and esophageal or gastric consideration is variceal bleeding, bleeding stopped in the short period of time, the use of three-cavity tube pressure;
establish guardianship records, the routine tests such as bleeding into the hemoglobin, RBC count, hematocrit, and subsequent liver and kidney function and blood coagulation mechanism of checks;
cardiac insufficiency of the elderly or those best placed central venous pressure tube;
shock for all patients, unless the suspect has CO2 retention disease, should be oxygen per minute via face mask 4L, and regularly check PH, PO2, PCO2 to monitor gas exchange, and to detect whether the acid-base balance disorder;
off in the sun after treatment no longer, gas micro-cold, white lips and pale face, sweating, pulse of micro-stricken patients, the available back-yang moxibustion, moxibustion with a moxa Guanyuan 15 minutes, fire and AIDS distance to the surface of the skin of patients can tolerate for the degree.
Hemorrhagic shock rescue circulating blood volume to make up the main channel in the establishment of patency of the infusion, it can quickly enter the first plasma substitutes, such as low molecular weight dextran, 706 on behalf of the plasma, so as to increase colloid osmotic pressure, restoration of effective blood volume and improve microcirculation, in order to rise blood pressure, urine output can be changed after the resumption of the maintenance infusion.
Restoration of effective blood volume, correction of hemorrhagic shock is the most effective blood transfusion. However, in the absence of sufficient blood in order not to lose or less the principle of blood transfusion to correct the shock. Mild and moderate bleeding, if not repeated a large number of re-bleeding, and bleeding under the condition of patients after the previous case, the above treatments, to maintain blood pressure, in general, better yet, you can not blood transfusion. Such as blood pressure instability or recurrent bleeding may be cases of severe bleeding, whole blood can be lost, the basic corrected shock can not blood transfusion. For acute upper gastrointestinal bleeding was rescued after transfusion, a good prognosis of this disease, or determine the surgery to stop bleeding and bleeding after surgical treatment of patients, and bleeding of unknown cause and location of those who require urgent examination, blood transfusion should be positive, but more should be early enough input use.
Require repeated blood transfusion and liver dysfunction a large number of those who pay attention to stop the bleeding disorder. Banked blood transfusion can quickly lead to instability of the first factor V and VIII deficiency, but these defects can be given fresh frozen plasma (FFP corrected, could each lose blood to a 3L bottle of fresh frozen plasma. And the need to pay attention to other bleeding disorders factors, for treatment, need to correct shock and blood transfusion during the same time to be addressed.
Do not need transfusions for mild, moderate bleeding cases and cases of post-transfusion to maintain recovery, and transfusion interval of the cases, use of Chinese medicine injections for intravenous injection or intravenous drip. Such as the Yin and the increasing use of liquid injection (habitat, Ophiopogon, Scrophulariaceae, etc.) 200m1; or by Shen Mai injection (ginseng, Ophiopogon japonicus) to 100ml by adding 500m15% glucose solution intravenously in order to save the Yin fluid. The bad blood off, yang storm off the case, the use of parameters with blue (red ginseng, aconite, blue, etc.) to join 500m15% Injecti00ml rapid intravenous infusion of glucose saline; also be integrated real injection (citrus aurantium ) 5 ~ 10ml 20ml by adding 25% glucose solution intravenously in the first carried out slowly, to back off yang solid.
Before the effective circulating blood volume in the supplement generally do not advocate the use of vasopressors. If the effective circulating blood volume has been to complement, blood pressure is still not restored, you can use as appropriate, and actively look for other causes of recovery.
3. Erosive gastritis and peptic ulcer hemorrhage
Gastric hypersecretion and peptic ulcer and mucosal barrier dysfunction is a major factor in erosive gastritis, in addition to the above measures can be the appropriate choice for bleeding to stop bleeding, the antacids and mucosal protective agent is often used to stop bleeding measures; cimetidine can reduce stomach acid - the amount of pepsin, and suggested that this H2 receptor antagonist can be written in the mucosal site of injury caused by antagonizing histamine vasodilation, thereby reducing bleeding. Routine use of multi-purpose 400 ~ 1200mg/24 hours, 3 times on the infusion of intravenous fluid carve, use 1 to 2 weeks after the switch to oral maintenance. Some noradrenaline 8 ~ 10mg dissolved in saline 100 ~ 250ml of ice, the sub-sub-oral bleeding. Although able to shrink blood vessels, but large or excessive temperature of the brine, on the mucosa may affect blood circulation, while the larger vessels of the blood they be able to play a role, further research is needed.
4. Cirrhosis of the liver treatment of esophageal variceal bleeding
In addition to more general use methods and gastroesophageal endoscope to stop bleeding with injection of sclerosing agent to stop bleeding, the frequent use of the emergency stop bleeding, or hemostasis three-cavity tube, the amount of bleeding is better; on the bleeding, before surgery can be used as emergency measures to stop bleeding, bleeding in patients on saving lives, for emergency surgery can play a decisive role. Vasopressin or vasopressin infusion for the treatment of cirrhosis and esophageal varices old drug, make visceral small artery contraction or to intrahepatic artery, portal vein shunt closed, reducing portal pressure and bleeding, and may contribute to intestinal peristalsis, a mild cathartic effect, beneficial intestinal fluid clearance, but coronary heart disease, hypertension, heart failure, pregnant women, which do not apply. Available when using pituitrin 10U plus 5% glucose 20m1, slow intravenous injection, or by adding 10% glucose 200ml 20u intravenous infusion, 1h drops finished. The second day. The side effects are heart palpitations, chest tightness, abdominal pain, nausea and so on. Prone to cause contraction of the hepatic artery for its oxygen liver cells, it is not longer available, only to stop the blood. Adverse effects on the cardiovascular system, the recent use of vasopressin in the same time, such as continuous infusion of vasopressin 0.33 ~ 0.4U / min, and given sublingual nitroglycerin 0.6mg every 30 minutes, or with 40ug / minute intravenous infusion at the same time, it may prevent cardiovascular complications and side effects.
Recent studies, oral -blocker propranolol 20 ~ 180mg, 2 times / day, the heart rate by 25% of the drug can significantly reduce portal pressure, the bleeding stopped after 10 to 15 days continuous use, Recent prevent rebleeding and reduce the rate of rebleeding.
Recently reported that calcium channel blockers verapamil after intravenous injection of 10mg, allows hepatic venous wedge pressure and free hepatic venous pressure in the pressure drop of 14%. Nitropyridine (nifedipine) by oral or sublingual 10mg, 3 times / day, also reduced acute bleeding after rebleeding. And suggested that tetrandrine prime the best, and inhibit the fibrosis of liver fibrosis. In addition, there by the splanchnic vascular hemostasis, including selective arterial infusion of vasoconstrictors to the bleeding vessel and the percutaneous portal vein embolization therapy to stop bleeding, but technical difficulties, side effects and more difficult to accept such patients, difficult to promote.
5. Emergency surgical treatment of ineffective conservative treatment, recurrent bleeding, or who have other surgical indications, emergency surgery should be considered. Various diseases of upper gastrointestinal bleeding caused by surgical indication should be based on a variety of different circumstances.
6. Surgical treatment
In case of upper gastrointestinal bleeding in patients following surgical treatment should be taken: an active medical therapy fails to stop bleeding more than 24 hours, or continuous blood pressure can not maintain more than 800ml; Internal bleeding, the short-term and repeated bleeding; gastroscopy hemorrhage stoves for small arteries spurting, can be considered surgery. According to statistics, over 65 years old patients with upper gastrointestinal bleeding, emergency surgery with high mortality rates of 9 times for elective surgery, so medical treatment if a temporary stable disease, elective surgery should be the method adopted.
About 1.5% to 22% of patients with recurrent ulcer bleeding, endoscopic examination revealed erosive ulcer bleeding parts of the artery or angiographic contrast agent extravasation, the indications for surgical treatment are. Surgical subtotal resection of gastric, vagotomy, pyloroplasty or vagotomy plus pylorus resection. Can also be cause for a variety of other surgical treatment options, such as tumor resection, Mallory-Weiss repair and so on. Room rates of colon disease or intestinal bleeding caused by telangiectasia, in addition to intravascular infusion of vasopressin, but also for segmental intestinal resection.Main symptoms: hematemesis dim, and continual, when light weight, body tired Shenpi, form, color except for quenching, palpitations, dizziness, stool color black, thin white fur, the pulse small and weak.
Therapeutic: Qi and spleen, nourishing bleeding.
Prescription: Decoction spleen, Codonopsis 12g, Radix Astragali 12g, Bai Zhu 9g, Poria 9g, angelica 12g, white peony root 9g, Chinese yam 12g, Rehmannia 12g, Baiji 9g, Agrimony 12g, Shuijianbi.
2. Positive heat of the stomach
Main symptoms: epigastric hot ache, nausea, vomiting blood and more generic, color dark red or purple, or there are the food debris, bad breath, constipation and the color black, red, yellow fur, slippery pulse.
Therapeutic: Qingwei purging fire, cooling blood to stop bleeding.
Prescription: Xie Xin Decoction, rhubarb 19g, Coptis 6g, Astragalus 9g, habitat 15g, Qian root carb5g, Baiji 12g, 12g Shuijianbi the size thistle.
3. Fan Wei anger card
Main symptoms: vomiting bright red, mouth pain hypochondriac pain, upset good anger, sleep soundly little more than dreams, irritability, red tongue purple, pulse a few strings.
Therapeutic: Liver purging fire, and stomach bleeding.
Prescription: Modified Danzhi Xiaoyaosan, Dan 9g, gardenia 9g, Angelica 9g, white peony root 9g, Bupleurum 6g, Poria 9g, Bai Zhu 9g, habitat 15g, gentian 9g, white peony root 9g, Shuijianbi.
4. Intestinal damp
Main symptoms: bright red blood under, anal pain, after the first blood, stool poor, yellow greasy moss, pulse a few slip.
Therapeutic: heat dehumidification, cooling blood to stop bleeding.
Prescription: Sophora japonica L. Sanguisorba Powder for Powder, SJ 24g, Oriental Arborvitae 12g, lotus 9g, Coptis 6g, Angelica 9g, Gardenia 9g, Shuijianbi.
5. Bad blood off the card
Main symptoms: vomiting blood or blood in the stool, pouring a bowl earnings, looking lips and a pale, heart palpitations, dizziness, irritability, dry mouth, cold sweat dripping limbs Jueni, oliguria color yellow, God indistinct or coma, pink tongue, rapid pulse, weakness, or fine For Jue.
Therapeutic: Qi taken blood, solid off back to Yang.
Prescription: Decoction alone, Shen Fu Tang, ShengmaiYin addition and subtraction, wild ginseng 6 ~ 9g, thick fried, or nasal feeding frequently fed, wild ginseng, or Panax quinquefolius 6 ~ 9g 9 ~ 12g, 6 to 9 grams gun monkshood, the 3g thick fried, or nasal fed frequently ginseng 6 ~ 9g, Sean 15g, licorice 10g, thick fried, or nasal fed frequently.
Special party prescription
1. Agrimony cream: Agrimony amount, made Agrimony extract orally, each 15g, 1 2 or 3 times, the effectiveness of moisture bleeding, treating vomiting blood, blood in the stool.
2. Four Hong Wan: Angelica charcoal, Puhuang charcoal, gelatin beads, rhubarb carbon, carbon Huaihua the 60g, made into pill, each pill weight 9g, 2 or 3 times a day, every time a pill, the effectiveness of cooling blood to stop bleeding Law stasis, attending vomiting blood, Nvxue, blood in the stool.
3. Daji San: also known as Daji-inducing Daji root, rhinoceros horn, Cimicifuga, fried Puhuang, almonds, fried Campanulaceae, moxibustion Morus alba 30g, licorice 15g, for the thick end, each serving 12g, add ginger 5 films, Shuijianbi. Effects: Clearing Heat evil, cooling blood to stop bleeding, hematemesis hematemesis attending.
4. Heart wins San: Rehmannia, thistle, ginseng, fried Puhuang, angelica, Chuanxiong, ebony all 30g, for the thick end, each serving 15g, Shuijianbi, efficacy and blood, bleeding, vomiting blood hematemesis attending.
5. Five God Soup: Health Ouzhi, thistle juice, juice of raw land 30m1, ginger juice 7m1, honey 15h1, co-fry 2 to 3 boiling, each with 15m1, transfer noodles 3g, before eating service. Efficacy: detoxification, cooling bleeding, heat treating drug upside, vomiting cease.
Chinese medicine treatment
More use of prescription medicine, or bleeding into agent agreements, such as: Yunnanbaiyao 1g, 3 times / day; notoginseng powder 3g, 3 times / day; ten gray powder 10g, 3 times / day; rhubarb ethanol tablets (powder) 3g, 3 times / day, purple ground mixture (Callicarpa grass, to twist grass) 50m1, 4 times / day, Ukraine, and scattered 6g, 2 ~ 3 times / day; can enter Yunnanbaiyao 0.5g, swallow.
Rhubarb injection in injection, Panax notoginsenoside injection, cattle cc injection, blood Injection, etc.; In addition, the Sweet Basil can also be used for drug injection vein, 20ml 40ml 5% glucose plus slow intravenous injection, 1 or 2 times / day, or 40ml 500ml in a 10% glucose intravenously.
Liquid compound gall to gall 15g, myrobalan 5g, add water 100m1, fry about dump 50ml; add water 80m1, boiling filtered, the second decoction combined into 30m1, plus alum 5g, dissolved after heating, filtration, and then glycerol 30m1, endoscopic injection 3ml in bleeding sites


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