摘要
目的回顾性分析危险性急性上消化道出血的急诊治疗方法，以提高治疗水平，并比较AIMS65评分、Glasgow-Blachford（GBS）评分、Pre—Rockall评分在预后评估中的准确性，评价他们的临床价值。方法收集2013年11月1日至2017年5月31日北京积水潭医院急诊科收治的危险性急性上消化道出血患者141例，回顾分析治疗方法及结果。所有患者均在急诊抢救室接受药物治疗，并联合多个科室对部分患者行内镜检查、介入治疗或手术治疗。分别计算三种评分的分值，以院内死亡或30d内死亡、再出血为终点指标，绘制ROC曲线，比较曲线下面积（AUC）以评价3种方法的优劣。结果内镜检查65．25％（92／141），出血病因首位是消化性溃疡，占64．12％。8例内镜下止血夹治疗，4例硬化治疗，4例三腔二囊管压迫止血，9例介入栓塞（therapeutic embolization approach，TEA）治疗，3例经颈静脉肝内门体支架分流术（TIPS），2例手术治疗。再出血率14．18％，病死率11．35％。AIMS65、Pre—Rockall在预测病死率方面优于GBS，而预测再出血率差异无统计学意义。结论药物联合内镜、介入、外科手术等可有效救治危险l生上消化道出血，AIMS65、Pre—Rockall评分法使用简便，均能准确预测患者病死率，适用于急诊对上消化道出血的风险评估。
Objective To retrospectively analyze the emergency treatment in 141 patients with high-risk of acute upper gastrointestinal bleeding（AUGIB） in order to improve the efficacy of treatment. In addition, to evaluate the predictive values in accuracy terms of AIMS65, Glasgow-Blachford（GBS） and Pre-Rockall scores for risk stratification in AUGIB by comparison among them. Methods Data of 141 patients with AUGIB admitted from Nov. 1,2013 to May 31,2017 in our emergency department（ED） were retrospectively analyzed. All patients at first were treated with pharmacologic therapy in emergency room, and some of them underwent endoscopic remedy, intervention or surgery as a last resort. The scores of AIMS65, Glasgow-Blachford（GBS） and Pre-Rockall scores were calculated respectively, and the in- hospital 30-day death and re-bleeding were taken as the study endpoints. Comparison of clinical value among the three scores was carried out by plotting their ROC and calculating the AUC. Results Of them, 65.25% patients underwent endoscopy, and the leading cause of bleeding was peptic ulcer （64.12%）. Endoscopic hemostatic clips were used in 8 cases, endoscopic sclerotic therapy in 4 cases, balloon tamponade in 4 cases, TEA （therapeutic embolization approach） in 9 cases, TIPS （trans-internal jugular vein for making hepatic portal vein shunt by stent） in 3 cases, and surgical intervention in 2 cases. Re-bleeding rate was 14.18%, death rate 11.35%. AIMS65 and Pre-Rockall were better than GBS in predicting in-hospital 30-day mortality. There was no difference in predicting re-bleeding among these three scores. Conclusions Medicines combined with endoscopy, various interventions and surgical operation can effectively treat high-risk patients with AUGIB. Both AIMS65 and Pre-Rockall are able to predict mortality accurately with easy practice. Both are suitable in ED to stratify the risk of AUGIB.
作者
涂家红
张明清
赵斌
Tu Jiahong;Zhang Mingqing;Zhao Bin(Emergency Department, Beijing Jishuitan Hospital, Beijing 100035, China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2018年第5期518-523,共6页
Chinese Journal of Emergency Medicine
关键词
危险性急性上消化道出血
内镜治疗
介入治疗
危险分层
预后评估
High-risk acute upper gastrointestinal bleeding
Endoscopic therapy
Interventional treatment
Risk stratification
Prognosis prediction
