ANALYSIS OF MORTALITY IN PATIENTS WITH BLEEDING GATRIC ULCERS
A.A. AZIMOV, Y.R. MALIKOV, A.A. MADAMINOV
Branch of the Republican Scientific Center for Emergency Medical Care,
Purpose - to compare the results of mortality in patients with bleeding gastric ulcers (BGU) at the stages of urgent medical aid (UMA).
The total number of patients involved into the analysis constituted 565 patients: 1st period (1990-2000.) covers the period till the appearance of UMA centers in the Republic - 144 (25.5%) patients; 2nd period (2001-2009.) covers the period after appearance of UMA centers in the Republic and its 12 regional branches, capable of providing 24-hour staged specialized UMA in accordance with accepted standards. Prospectively total of 421 (74.5%) patients were studied within the period.
It was noted that the clinical outcomes in patients with BGU depending on the application of active-differentiated tactics are more favorable in the 2nd period. Conservative treatment in the 2nd period of the study was conducted in 338 (80.3%) patients, surgical operations were performed in 83 (19.7%) patients. Consequently, the operational activity due to the use of active-differentiated tactics in the second period significantly reduced to 19.7% as compared to the first period, where the operative activity was at the level of 64.6% (Rχ2 <0.001). Given that most deaths occur after surgical interventions, reduction of the operational activity has led to improvement of results of treatment. This influenced the postoperative mortality in the 2nd period, which insignificantly reduced to 4.8% versus 9.7% in the first period (P> 0.05). Total mortality rate in the second period was significantly reduced to 4.0% versus 11.1% in the 1st period I (P = 0.007). This is mainly connected with the decrease in the recurrence of bleedings, in the number of surgical operations, mainly in the delayed manner after preoperative preparation and correction of the hemostatic system in the post-hemorrhagic period. If to analyze the postoperative lethality in chronic BGU according to the type of operational interventions, it can be noted that after urgent operation patients died almost 2.1 times more often (25.0%) in the 1st period and 8.7 times - in the 2nd period (8.7%) than after urgent operations (11.8% in the 1st period). In this case the highest percentage of lethality was observed in palliative interventions (66.7%).
Date: 2014-12-28; view: 628