PDF (5 MB) - Jurnalul de Chirurgie

ARTICOLE ORIGINALE 387Jurnalul de Chirurgie (Iaşi), 2012, Vol. 8, Nr. 4ULCERELE DE STRES - ULCERELE CUSHING:DIAGNOSTIC, TRATAMENT, PROFILAXIER. Şcerbina , G. Ghidirim, A. Dolghii, V. Lescov,V. Burunsus, I. Glavan, Liliana FloreaCatedra chirurgie Nr. 1 „N. Anestiade”Universitatea de Stat de Medicină şi Farmacie „N. Testemiţanu” Chişinău, Republica MoldovaSTRESS ULCERS: CUSHING ULCERS, DIAGNOSIS, TREATMENT, PREVENTION(Abstract): BACKGROUND: Cushing ulcers appear at the 3rd to 5th day after stress situationsaccompanied with hemorrhage in 5-10%, perforations in 4%. METHODS: Between 2007-2011 inthe National Scientific and Practical Center for Emergency Medicine Kishinev, 1917 patients withsuperior gastric hemorrhages were treated, from which 139 in ICU. RESULTS: In 45 cases werediagnosed Cushing ulcers: men – 30, women – 15 with age between 21 years and 87 years. Thedisease causes were: cerebral vascular diseases 13(28.8%); fractures with hip replacement – 16(35.5%); chronic renal insufficiency and septic states - 3 (12. 32%); severe head trauma – 10(22.2%). The mortality rate was 22.2% (10 patients). Gastroscopy revealed hemorrhages followedby endoscopic hemostasis. For the prophylaxis of hemorrhage relapse all patients underwentrepeated endoscopic hemostasis 2 to 3 times. One patient was operated for a perforated bulbarCushing ulcer and another one due to Forrest IA hemorrhage that didn’t respond to endoscopichemostasis – Bilroth I antrum resection. Both patients died due to multiple organ dysfunctionsyndrome (MODS). Patients with Cushing ulcers received anti-ulcer treatment: PPI, H2 blockersin maximum dosages, hemostatic and repeated blood plasma transfusions. CONCLUSIONS:Gastroscopy is obligatory in all patients with severe head trauma, septic states, chronic renalinsufficiency and severe cerebral vascular diseases. Anti-ulcer and hemostatic treatment insuresulcer healing and scarring in most of the cases.KEY WORDS: CUSHING ULCERS; DIAGNOSIS; TREATMENTSHORT TITLE: Ulcerele CushingCushing ulcersHOW TO CITE: Şcerbina R, Ghidirim Gh, Dolghii A, Lescov V, Burunsus V, Glavan I, Florea L. [Stress ulcers - Cushingulcers: diagnosis, treatment, prevention]. Jurnalul de chirurgie (Iaşi). 2012; 8(4): 387-391.INTRODUCEREDeşi ulcerele de stress sunt cunoscutede multă vreme, ele rămân în actualitatedatorită complicaţiilor grave care aparevolutiv.MATERIAL ŞI METODĂAm urmărit retrospectiv frecvenţaulcerelor de stres din Centrul NaţionalŞtiinţifico-Practic de Medicină de Urgenţă(CNŞPMU) al Republicii Moldova dinperioada 2007–2011, consultând toateînregistrările medicale ale bolnavilor.S-au înregistrat 1917 bolnavi cuhemoragii digestive superioare (HDS), dintrecare 139 pacienţi au necesitat tratamentintensiv în secţiile de ATI (7,2%).REZULTATERepartiţia după sex şi vârstă pacienţiieste consemnată în Tabel I.Endoscopia digestivă superioară(EDS) a diagnosticat ulcere acute la 45pacienţi şi ulcere cronice la 94 pacienţi. ÎnTabelul II sunt repartizate leziunilehemoragice după etiologie.Received date: 10.01.2012Accepted date: 21.06.2012Adresa de corespondenţă: Conf. Dr. Romeo ŞcerbinaCatedra chirurgie Nr.1 „N. Anestiade”, Universitatea de Stat de Medicină şi Farmacie „N. Testemiţanu” ChişinăuBd. Ştefan cel Mare şi Sfânt, nr. 165; MD-2004, Chişinău, Republica MoldovaTel.: 00373 22 24 34 08Fax: 00373 22 24 23 44e-mail: romeo_scerbina@yahoo.com