【正文】 ＞1000ml,最有價值的標準:周圍循環(huán)衰竭的臨床表現 動態(tài)觀察(guānch225。,This duodenal ulcer at the left edge of the figure, shows an oozing, active bleeding. According to the Forrest classification of gastrointestinal hemorrhage of the upper GI tract, this bleeding is graded as Forrest Ib. The visible vessel is treated by primary application of a hemoclip. At the 3 week follow up (fig )the Clip is still in the original position. The ulcer shows a progressive healing.,第八頁，共二十五頁。 232。,上消化道出血(chū xiě)的確立,嘔血和黑糞,失血性周圍循環(huán)衰竭,血和糞便(f232。,出血(chū xiě)的病因,病史 實驗室檢查 胃鏡:首選。,藥物止血 生長抑素(somatostatin) 機制:減少內臟血流,減少奇靜脈血流 優(yōu)點:療效確實(qu232。ikē)治療,外科手術 適應癥:內科治療(zh236。MalloryWeiss 綜合征 310%。最有價值的標準:周圍循環(huán)衰竭的臨床表現。o)無效 應盡量避免,經頸靜脈門體靜脈分流術 尤其(y243。),無全身血流動力學改變 缺點:價格昂貴 用量: 14肽天然生長抑素:首劑250ug靜脈緩注, 繼以250ug/h靜脈滴注 注意:該藥半衰期短,中斷超過5分鐘須再次首劑 8肽生長抑素:首劑100ug靜脈緩注, 繼以25~50ug/h持續(xù)靜脈滴注,治療(zh236。tā):選擇性動脈造影,第十五頁，共二十五頁。n) 的檢查,早期識別(sh237。ng)和胃) 3351% 食管和胃靜脈曲張 23