Chukhriienko A. Features of treatment of ulcerative bleeding from the upper gastrointestinal tract in elderly patients

The purpose of the work: improvement of diagnostic and treatment tactics in the category of elderly patients with ulcerative gastrointestinal bleeding against the background of acute coronary syndrome due to the development of a scale for predicting the occurrence and recurrence of gastrointestinal bleeding based on studying the main clinical and immunological indicators. The dissertation work is based on the results of my own observations of conservative and surgical treatment, clinical, laboratory and instrumental methods of patients’ examination. The scientific work analysed the results of a retrospective cohort (n = 609) and a prospective (n = 85) study. The main group (n = 35) included patients diagnosed with peptic ulcer disease of the stomach and duodenum against the background of acute coronary syndrome (ACS). Depending on the type of therapy directed at the treatment for acute coronary syndrome, patients were divided into subgroup A (n = 20), who received monoantiplatelet therapy, and subgroup B (n = 15), who received dual antiplatelet therapy. Thete were also 50 patients of the comparison group (control) – without acute cardiovascular pathology, who did not receive antiplatelet therapy. No statistically significant gender differences were found between the groups (р = 0,984). A new approach to solving the current problem was scientifically substantiated, which involved improving the diagnostic and treatment tactics of managing elderly patients with gastrointestinal bleeding of ulcer genesis against the background of acute coronary syndrome using a developed scale for predicting the risk of recurrence of gastrointestinal bleeding. The feasibility of studying the relationship between the dynamics of the main indicators of the immune system, hs C-reactive protein and troponin T with the clinical and endoscopic picture has been confirmed. Expanded understanding of the risk factors for the occurrence of recurrent bleeding in the presented category of patients due to statistical studies (correlation analysis, ROC analysis, calculation of the odds ratio indicator). For the first time, it was proved using the logit-regression equation that the main predictors of recurrence of gastrointestinal bleeding in the algorithm of diagnostic and therapeutic tactics in elderly patients (61 – 89 years old) with ACS are the state of local endoscopic hemostasis F I – F II, troponin T > 0, hs CRP > 63 mg/l. With high and very high risks of recurrence of bleeding, the algorithm provides for surgical intervention according to the improved surgical treatment of bleeding ulcers. The main criteria for determining diagnostic and therapeutic tactics in patients with ulcerative gastrointestinal bleeding against the background of acute coronary syndrome have been determined. A scale for predicting the risk of recurrence of gastrointestinal bleeding in this category of patients is proposed. The feasibility of the algorithm for conducting diagnostics and choosing a treatment method in elderly patients with ulcerative gastrointestinal bleeding against the background of acute coronary syndrome has been developed and proven. An improved method of surgical treatment of a bleeding ulcer of the pylorobulbar department of the stomach has been developed and implemented into clinical practice, and a utility model patent № 139011 dated 12.10.2019 has been obtained, its effectiveness has been proven. The developed algorithm of diagnostic and therapeutic tactics in the category of elderly patients is aimed at improving the results of treatment of a group of patients with a high operative and anesthetic risk. The obtained data are appropriate for use in the practical activities of doctors and surgeons and in the educational process at departments of surgery.