The treatment of acute erosive gastritis
Also known as acute hemorrhagic gastritis, often a result of taking acetyl salicylic acid, phenylbutazone, indomethacin, adrenal cortical hormone, or because of alcohol abuse, severe trauma, major surgery, it is important organs (heart, liver, kidney) failure caused. A sudden onset of clinical disease based on upper gastrointestinal bleeding than the main performance, its about the incidence of upper gastrointestinal bleeding cause of 1 / 4 or more, after peptic ulcer bleeding. Light while only fecal occult blood positive, and most patients have hematemesis and melena. Hemorrhagic disease with repeated and intermittent seizures. The condition of this disease is usually more severe peptic ulcer bleeding, even after massive blood transfusion, hemoglobin increased more difficult.
In addition to bleeding, most patients have abdominal discomfort, abdominal pain, dizziness, fatigue, and loss of appetite and other symptoms. However, apart from physical examination the pulse of fast, pulse pressure decreases, anemia Maung and other signs of bleeding, in general, there are no other obvious signs of abnormalities.
Hemorrhagic gastritis, once diagnosed, the importance of timely treatment, to prevent heavy bleeding in patients, leading to life-threatening. Principle of treatment is to remove all kinds of triggers, lower gastric acidity to prevent the counter-diffusion of hydrogen ions aggravated gastric mucosal damage, active bleeding, blood transfusion rehydration. Specific measures are as follows:
(1) Supplementary blood volume: discretionary grant infusion of whole blood or fresh frozen plasma, generation of plasma and balanced salt solution, etc., there is shock, should actively improve microcirculation.
(2) ice-brine gastric lavage: can stomach the blood vessels, and to reduce gastric acid secretion and promote bleeding. Method is to stomach tube indwelling stomach, gastric juice exhausted first, into ice brine from 200 to 300 ml, and then out, repeatedly washed 3 to 4 times, and finally noradrenaline 4 mg in 250 ml ice-salt water, into the stomach in order to further contraction in blood vessels. 4 hours after repeated 1 times.
(3) H2 receptor antagonists application: H2 receptor antagonists such as cimetidine, ranitidine, famotidine have a stronger role in inhibiting gastric acid secretion, reducing hydrogen ion concentration. Under normal circumstances can be cimetidine 0.2 g, 6 hours a time; or ranitidine 150 mg, 12 hours a time, oral; in critical condition who used cimetidine 0.4 g or Raney 300 mg intravenous infusion for Ding.
(4) antacid: 0.75 grams per hour of oral sucralfate, or aluminum hydroxide and magnesium hydroxide mixture can neutralize stomach acid, to protect the gastric mucosa role.
(5) the fiber endoscopy or laser coagulation to stop bleeding, the effect reliably. Due to limitations of the current hard to popularize.
(6) selective intra-arterial angiography Vasopressin infusion in order to shrink blood vessels to achieve hemostasis purposes. At present the clinical application of less.
(7) The surgical treatment: the vast majority of patients by medical treatment can be bleeding, but still about 10% of patients had surgical treatment, otherwise difficult to control bleeding. Operation to use more vagotomy plus subtotal gastric resection.
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