Гастродуоденальные кровотечения у пациентов с ишемической болезнью сердца

А.М. Хаджибаев, Р.А. Рахимова, Б.И. Шукуров, Р.И. Рахимов

Abstract

Material and methods. The results of the treatment of ulcerative gastroduodenal bleeding (UGDB) in 413
patients with various forms of coronary heart disease (CHD) are presented. All patients were hospitalized
at the RRCEM in 2010 – 2020. There were 241 (58.4%) men and 172 (41.6%) women. The average age
of the patients was 70.7±9.2 years. Acute ulcers were observed in 283 (68.5%) of the examined, and in
130 (31.5%). The ulcerative process was chronic. All patients, regardless of the form of ischemic heart
disease, underwent esophagogastroduodenofibroscopy (EGDFS), in which the bleeding activity was assessed
according to Forrest’s classification (1974). In 149 (36.1%) patients, EGDFS was performed on the
background of acute coronary syndrome (ACS) – (118; 28.6%) and acute myocardial infarction (AMI) –
(31; 7.5%).
SHOSHILINCH TIBBIYOT AXBOROTNOMASI, 2021, 14-TOM, №1 5
Results. Continuing bleeding (F-1A and F-1B) was more often observed in acute gastric and duodenal
ulcers compared with chronic ulcers (21.9% versus 18.4%, χ2=4.449, p=0.035). Various methods of endoscopic
hemostasis were used in 301 (72.9%) patients with ongoing bleeding and with a high risk of recurrent
bleeding, and conservative therapy was used in 112 (27.1%) patients with ongoing bleeding. The
total recurrence rate of UGDB was 11.6%, after the use of endoscopic hemostasis – 7.3%, with conservative
therapy – 23.2%. In patients operated on for recurrent bleeding, postoperative mortality was 37.5%,
the frequency of acute coronary excesses was 66.7% with a mortality rate of 93.5%.
Conclusion. Endoscopic methods are the most reliable and safe methods of hemostasis in patients with
UGDB on the coronary heart disease background, with the lowest frequency of bleeding recurrences
(7.3%) and acute coronary syndromes (7.9%).