Introduction: Gastric bleeding is a serious gastrointestinal disease, and there are many causes of the disease. Patients should pay more attention to their diet and not let the condition become serious. So, how can patients with this disease be best treated?

What is the treatment for gastric bleeding?

1. General treatment

For severe bleeding, it is advisable to lie down with the lower limbs raised and the head sideways to avoid suffocation caused by blood reflux when vomiting a large amount of blood. If necessary, oxygen, fasting. For small amounts of bleeding, liquid food can be taken appropriately. Patients with liver disease should avoid taking morphine and barbiturates. Nursing care should be strengthened, blood pressure, pulse, bleeding volume and hourly urine output should be recorded, venous access should be maintained, and central venous pressure measurement and electrocardiogram monitoring should be performed if necessary.

2. Replenish blood volume

When the hemoglobin is lower than 70g/L and the systolic blood pressure is lower than 90mmHg, a sufficient amount of whole blood should be transfused immediately. Patients with cirrhosis should receive fresh blood. The infusion should be started quickly, but the elderly and those with cardiac insufficiency should not transfuse too much or too fast, otherwise it may lead to pulmonary edema. It is best to monitor central venous pressure. If blood source is difficult, dextran or other plasma substitutes can be given.

3. Hemostatic measures

(1) Drug treatment

When esophageal and gastric varices rupture and bleed, pituitaryin is a commonly used drug, but its effect The time is short and small doses of medication are recommended. It should not be used by those suffering from hypertension, coronary heart disease or pregnant women. Some people advocate taking nitroglycerin or isosorbide dinitrate sublingually at the same time. For peptic ulcer and erosive gastritis bleeding, 8 mg of norepinephrine mixed with 100 ml of ice saline can be taken orally or as a nasogastric infusion. Thrombin can also be used orally.

(2) Three-lumen balloon tube for compression and hemostasis

Suitable for esophageal and gastric variceal bleeding. If the drug is not effective in stopping bleeding, consider using it. This method has obvious immediate hemostatic effect, but technical operating procedures must be strictly followed to ensure the hemostatic effect and prevent complications such as suffocation and aspiration pneumonia.

(3) Hemostasis under direct endoscopic vision

For patients with portal hypertension bleeding, ① emergency esophageal variceal ligation; ② injection of tissue glue or sclerosing agent such as B Oxysterol, cod liver oil sodium, etc. Generally, it is recommended to use H2 receptor antagonist or omeprazole after injection to reduce ulcers and bleeding caused by gastric acid after sclerosing agent injection; for patients with non-portal hypertension bleeding, ① local injection of 1/10000 epinephrine saline; ② Use APC electrocoagulation to stop bleeding; ③ Blood vessel clip (titanium clip) to stop bleeding.

(4) Vascular interventional technology

For patients with esophageal-gastric variceal bleeding who have failed transpituitarin or three-lumen balloon tube compression treatment, transcervical Venoportosystemic shunt surgery (TIPS) combined with gastric coronary vein embolization.

(5) Surgical treatment

After the above treatment, most upper gastrointestinal bleeding can be stopped. If still ineffective, surgical treatment may be considered. For ruptured esophageal and gastric varices, surgery such as oral or splenorenal vein anastomosis may be considered. Early surgery can reduce mortality in patients with massive bleeding from gastric and duodenal ulcers, especially the elderly who are not suitable for hemostasis and are prone to recurrence, so early surgery is more appropriate. For example, patients with ulcer perforation, pyloric obstruction, or suspected ulcer malignancy should undergo timely surgery.