TREATMENT TACTICS OF PATIENTS WITH ACUTE ULCERATIVE BLEEDING

Improving the treatment tactics of patients with acute ulcerative bleeding (AUB) is a topical problem. This is due to the high frequency of recurrent AUB and mortality. The aim of the work has been a prior assess-ment of the effectiveness of well-established tactics for treating patients with AUB. Materials and methods. 113 patients with ul-cerous disease complicated by AUB. 58 (51.33%) pa-tients had a duodenum ulcer, 44 (38.94%) had a stomach ulcer, and 11 (9.73%) had multiple ulcers. There was a Forrest I class (Ia – 12, Ib – 9) in 21 (18.58%) patients during primary EGDS, and 92 patients (81.42%) had a Forrest II class (IIa – 13, IIb – 34, IIc – 45). Patients have been treated by a well-developed algorithm. Results. The basis of the chosen tactics was de-veloped by us a prognostic scale which provides prelimi-nary and basic stages of forecasting. The preliminary stage scale contains clinical (comorbid pathology class, features of ulcerative anamnesis, body temperature, use of hemostatic therapy at the pre-hospital stage, pulse rate, pulse pressure), and endoscopic criteria (Forrest class). The two risk groups for recurrent AUB have been distinguished. The low and high one. If there is a Forrest II class, preventive endoscopic hemostasis should be performed to patients with a high risk. If there are patients with Forrest І, IIa, IIb stigmata, and who are at high risk, the injections of a mixture of gelatin liquid with epinephrine 1: 20 should be done. When it is Forrest IIc stigmata, we use application hemostasis, blowing of the organ wall with air-cooled to-900C primarily. The main scale contains laboratory data as fol-lows: the total number of white blood cells, total protein, creatinine, prothrombin index, plasma recalcification time, test for fibrinogen B, fibrinase, antithrombin III, reduced glutathione, the ratio of non-fermentative and fermentative fibrinolytic plasma activity, plasma proteo-lytic activity by azocolagen, the level of neutral plasma proteins oxidation, the content ratio of diene conjugates and cetodienes, 5g4 and g43a polymorphism of the PAI-1 gene). After evaluation by the main scale, patients with high risk undergo a control EGDS, and endoscopic he-mostasis, if necessary. The treatment complex for such patients is complemented by regulators of the oxidative and proteolytic reactions, hepato - and nephroprotection . Using this tactic, we have treated 26 patients, including 17 (65.38%) men and 9 (34.62%) women. 14 (53.85%) patients had a duodenum ulcer, 12 (46.15%) patients – a stomach ulcer. 7 (26.92%) patients with primary EGD have had Forrest I class (Ia – 4, Ib – 3), and 19 (73.08%) patients - Forrest II class (IIa – 5, IIb – 12, IIc – 9). 14 patients have had a high risk of recurrent AUB. No com-plications have been observed after using the well-established methods of EG. No relapses of bleeding. Conclusions. 1. The developed algorithm, based on a group's allocation of high and low risk of re- bleed-ing, allows to determine the treatment tactics of patients and improve the treatment complex. 2. The two-stage developed prognostic scale al-lows to identify risk groups of recurrence at the stage of endoscopic examination and specify the risk after laboratory examinations. 3. Clinical testing of the algorithm indicates its effectiveness and proper implementation in further wide-spread practice.