surgoncoКреативная хирургия и онкологияCreative surgery and oncology2076-30932307-0501Башкирский государственный медицинский университет10.24060/2076-3093-2018-8-3-225-230surgonco-336Research ArticleОБЗОР ЛИТЕРАТУРЫREVIEWSТактика интенсивной терапии при желудочно-кишечных кровотечениях на фоне портальной гипертензииIntensive Care Tactics for Reducing Gastrointestinal Bleeding in the Context of Portal HypertensionБаялиеваА. Ж.BayaliyevaA. Zh.

врач — анестезиолог-реаниматолог ГКБ № 7, зав. кафедройанестезиологии и реаниматологии, медицины катастроф КГМУ, зав. кафедрой анестезиологии-реаниматологии и трансфузиологии КГМА,

Physician Anesthesiologist, Head of the Department of Anesthesiology and Intensive Care Medicine and Disaster Medicine, Head of the Department of Anesthesiology and Intensive Care Medicine and Transfusiology, 49 Butlerova str., Kazan, 420012, Russian Federation; 54 Chuikova str., Kazan, 420103, Russian Federation; 11 Mushtari str., Kazan, 420012, Russian Federation.

ЯнковичЮ. Н.YankovichJu. N.

врач — анестезиолог-реаниматолог, Россия, 420103, Казань, ул. Маршала Чуйкова, 54.

Physician Anesthesiologist, 54 Chuikova str., Kazan, 420103, Russian Federation.

НагимуллинР. Р.NagimullinR. R.

врач — анестезиолог-реаниматолог, ассистент кафедры анестезиологиии реаниматологии, медицины катастроф КГМУ, тел.: +7 (927) 426-77-43, Россия, 420012, Казань, ул. Бутлерова, 49; Россия, 420103, Казань, ул. Маршала Чуйкова, 54.

Physician Anesthesiologist, Assistant lecturer of the Department of Anesthesiology and Intensive Care Medicine and Disaster Medicine, tel.: +7 (927) 426-77-43, 49 Butlerova str., Kazan, 420012, Russian Federation; 54 Chuikova str., Kazan, 420103, Russian Federation.

edem_balasi@bk.ruДавыдоваВ. Р.DavydovaV. R.

врач — анестезиолог-реаниматолог, ассистент кафедры анестезиологиии реаниматологии, медицины катастроф КГМУ, Россия, 420012, Казань, ул. Бутлерова, 49; Россия, 420103, Казань, ул. Маршала Чуйкова, 54.

Physician Anesthesiologist, Assistant lecturer of the Department of Anesthesiology and Intensive Care Medicine and Disaster Medicine, 49 Butlerova str., Kazan, 420012, Russian Federation; 54 Chuikova str., Kazan, 420103, Russian Federation.

Казанский государственный медицинский университет; Городская клиническая больница № 7; Казанская государственная медицинская академия — филиал ФГБОУ ДПО РМАНПО.РоссияKazan State Medical University; City Clinical Hospital No. 7; Kazan State Medical Academy.Russian FederationГородская клиническая больница № 7.РоссияCity Clinical Hospital No. 7.Russian FederationКазанский государственный медицинский университет; Городская клиническая больница № 7.РоссияKazan State Medical University; City Clinical Hospital No. 7.Russian Federation20182601201983225230Copyright © Баялиева А.Ж., Янкович Ю.Н., Нагимуллин Р.Р., Давыдова В.Р., 20192019Баялиева А.Ж., Янкович Ю.Н., Нагимуллин Р.Р., Давыдова В.Р.Bayaliyeva A.Z., Yankovich J.N., Nagimullin R.R., Davydova V.R.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surgonco.ru/jour/article/view/336

Введение. В настоящее время одной из значимых патологий, обусловливающих летальность, является желудочно-кишечное кровотечение. Факторами роста частоты развития кровотечений стало как распространение гастроинтестинальной патологии ввиду нарушений пищевого поведения, инфицирования Helicobacter pylori, так и рутинное использование в амбулаторной практике антикоагулянтов. Различные причины, приведшие к развитию кровотечения, уровень поражения ЖКТ требуют дифференцированного подхода к терапии. Помимо хирургического гемостаза пациентам требуется также фармакологическая поддержка. Здесь мы рассмотрим подходы к медикаментозной терапии одного из наиболее распространенных вариантов желудочно-кишечного кровотечения — кровотечения из варикозно расширенных вен пищевода. Данная проблема наиболее актуальна в связи с распространением гепатитов вирусной этиологии, а также алиментарно-токсического генеза, имеющих в исходе цирроз печени.Материалы и методы. В обзоре рассмотрены приоритетные методики терапии пациентов с желудочно-кишечным кровотечением в зависимости от этиопатогенетических факторов.Заключение. Адекватная фармакотерапия кровотечения из варикозно расширенных вен пищевода имеет большее значение, нежели хирургические вмешательства, как для профилактики, так и для гемостаза и последующего контроля развития повторного кровотечения. Очевидно, что применение вазоактивных препаратов улучшает прогноз и эффективность применения эндоскопического лигирования варикозно расширенных вен пищевода, баллонной тампонады, портосистемного шунтирования, а бета-адреноблокаторы играют значимую роль в первичной и вторичной профилактике.

Introduction. Gastrointestinal bleeding is currently one of the most significant pathologies indicating lethality. Factors in the incidence of gastrointestinal bleeding include the spread of gastrointestinal diseases caused by eating disorders, Helicobacter Pylori infection and routine use of anticoagulants. The various causes leading to the development and level of bleeding in the gastrointestinal tract require a differentiated therapeutic approach. In addition to surgical haemostasis, pharmacological support is also required. In the article, we consider medicamentous therapeutic approaches to bleeding due to phlebeurysm, which is one of the most common causes of gastrointestinal bleeding. This problem is very relevant due to the spread of hepatitis and alimentary toxicity having cirrhosis as the outcome.Materials and methods. The review considers the priority methods for treatment of patients with gastrointestinal bleeding, depending on the etiopathogenetic factors.Conclusion. Adequate pharmacotherapy of bleeding from varicose veins of the esophagus is more important than surgical interventions, both for prevention and for haemostasis and subsequent control of the development of re-bleeding. Obviously, the use of vasoactive drugs improves the prognosis and effectiveness of endoscopic ligation of esophageal varicose veins, balloon tamponade, portosystemic shunting, and beta-blockers play a significant role in primary and secondary prevention.

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The authors declare that there are no conflicts of interest present.