發(fā)布時(shí)間：2018-05-25 19:57

  本文選題：胃腸出血 + 急性非靜脈曲張性上消化道出血　； 參考：《中國(guó)全科醫(yī)學(xué)》2017年14期

【摘要】：背景成年人急性非靜脈曲張性上消化道出血(ANVUGIB)是常見的臨床急癥,起病急、病情變化快,嚴(yán)重者可危及生命。如何迅速、準(zhǔn)確地評(píng)估病情,快速分診,制定合理的治療方案是高效應(yīng)用現(xiàn)有醫(yī)療資源,改善ANVUGIB患者預(yù)后的關(guān)鍵。目的探討Glasgow-Blatchford評(píng)分(GBS)、AIMS65、Rockall評(píng)分系統(tǒng)對(duì)ANVUGIB患者危險(xiǎn)分層評(píng)估的準(zhǔn)確性和預(yù)測(cè)價(jià)值。方法選取2013—2015年天津醫(yī)科大學(xué)總醫(yī)院急診科收治并確診為ANVUGIB的246例患者,收集患者基本信息,并采用GBS、AIMS65、Rockall評(píng)分系統(tǒng)對(duì)患者進(jìn)行危險(xiǎn)分層。評(píng)估3種評(píng)分系統(tǒng)預(yù)測(cè)ANVUGIB患者干預(yù)、再出血、死亡的靈敏度、特異度、陽(yáng)性預(yù)測(cè)值、陰性預(yù)測(cè)值及受試者工作特征(ROC)曲線下面積(AUC)。結(jié)果 246例患者中干預(yù)95例(38.6%),再出血15例(6.1%),死亡4例(1.6%)。GBS2分時(shí),0例需干預(yù)、再出血和死亡;AIMS65評(píng)分2分時(shí),19例需干預(yù),1例再出血,1例死亡;Rockall評(píng)分2分時(shí),6例需干預(yù),1例再出血,0例死亡。當(dāng)GBS、AIMS65、Rockall評(píng)分≤2分時(shí),預(yù)測(cè)ANVUGIB患者需干預(yù)的靈敏度和特異度分別為100.0%、80.0%、93.7%和26.5%、45.7%、15.9%,陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值分別為46.1%、48.1%、41.2%和100.0%、78.4%、80.0%,AUC分別為0.675[95%CI(0.580,0.679)]、0.643[95%CI(0.545,0.741)]、0.653[95%CI(0.553,0.752)];預(yù)測(cè)再出血的靈敏度和特異度分別為100.0%、93.3%、93.3%和17.3%、37.7%、12.6%,陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值分別為7.3%、8.9%、6.5%和100.0%、98.9%、96.7%,AUC分別為0.809[95%CI(0.638,0.941)]、0.720[95%CI(0.643,0.873)]、0.800[95%CI(0.597,0.907)];預(yù)測(cè)死亡的靈敏度和特異度分別為100.0%、100.0%、75.0%和16.5%、36.0%、12.4%,陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值分別為1.9%、1.9%、1.8%和100.0%、98.9%、100.0%,AUC分別為0.848[95%CI(0.707,0.930)]、0.804[95%CI(0.723,0.976)]、0.838[95%CI(0.597,0.968)]。結(jié)論 GBS更適合急診,GBS≤2分時(shí),可被視為低風(fēng)險(xiǎn)患者,低風(fēng)險(xiǎn)患者可以接受門診治療,緩解住院壓力和減少醫(yī)療資源浪費(fèi)。
[Abstract]:Background Acute non-varicose upper gastrointestinal hemorrhage (ANVUGIBB) is a common clinical emergency in adults. How to evaluate the disease quickly and accurately, how to quickly divide the patients, and how to make a reasonable treatment plan are the key to use the existing medical resources efficiently and improve the prognosis of patients with ANVUGIB. Objective to evaluate the accuracy and predictive value of Glasgow-Blatchford scoring system in assessing risk stratification in patients with ANVUGIB. Methods two hundred and forty-six patients with ANVUGIB were selected from the emergency department of Tianjin Medical University General Hospital from 2013 to 2015. The basic information of the patients was collected and the risk stratification was carried out by using GBSU AIMS65 Rockall scoring system. The sensitivity, specificity, positive predictive value, negative predictive value and area under the operating characteristics curve of ANVUGIB patients were evaluated for predicting the intervention, rebleeding, mortality, specificity, positive predictive value, negative predictive value and area under the operating characteristics curve of the patients with ANVUGIB. Results among 246 patients, 95 cases were treated with intervention (38.6%), 15 cases with rebleeding (6. 1%), 4 cases with death (1. 6%). GBS2 (0 cases) needed intervention. 19 cases need to intervene in 1 case of rebleeding and 1 case of death Rockall score of 2 minutes. 6 cases need to intervene in 1 case and 1 case of bleeding again. 0 case died. When GBSU AIMS65 Rockall score 鈮，

本文編號(hào)：1934479