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Gastroenterology report:重症监护病房患者上消化道出血的死亡率和内窥镜干预的预测指标分析

2020-10-17 网络 网络

上消化道出血(UGIB)是入院以及收治重症监护病房(ICU)的常见原因。UGIB的死亡率大概在5%至15%之间。

        上消化道出血(UGIB)是入院以及收治重症监护病房(ICU)的常见原因。UGIB的死亡率大概在5%至15%之间;尽管预防消化性溃疡出血以及使用大剂量质子泵抑制剂治疗方面取得了进展,近几十年来死亡率一直保持稳定。在重症监护病房(ICU)接受食管胃十二指肠镜检查(EGD)治疗上消化道出血(UGIB)患者的转归没有得到很好的研究,因此,本项研究旨在对此进行相关探索。

 

 

        研究人员通过回顾病例确定了2008年至2015年在ICU住院的患者进行了EGD的情况。使用Logistic回归确定与30天死亡率和内镜干预相关的因素。使用接收者操作特征区域(AUROC)分析来评估已建立的UGIB评分系统,以预测就诊为UGIB的患者的死亡率和内窥镜干预的预测因素。

 

 

        共有606名患者在接受ICU时接受了UGIB的EGD治疗。该队列的中位年龄为62岁,男性为55.9%。多因素分析显示,与30天死亡率相关的预测因素包括美国麻醉医师学会(ASA)分类([OR] 4.1,95%[CI] 2.2-7.9),Charlson评分(OR 1.2,95%CI 1.0–1.3),以及从入院到EGD的持续时间(OR 1.04,95%CI 1.01–1.07)。Rockall,Glasgow-Blatchford和AIMS65得分对内镜干预分别为0.521、0.514和0.540的预测概率,对院内死亡率分别有0.510、0.568和0.506的预测概率。

 

        本项研究发现对出现上消化道出血的重症监护患者与30天死亡率相关的预测因素包括ASA分类,Charlson评分和EGD之前在医院的住院时间。

 

 

原始出处:

Vijaya L Rao. Et al. Predictors of mortality and endoscopic intervention in patients with upper gastrointestinal bleeding in the intensive care unit. Gastroenterology Report.2020.

 

 

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    2020-12-12 zhouqu_8
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  5. 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  6. 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  7. 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    2020-10-19 bioon6

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研究认为,AI系统在高危上消化道出血患者识别中的应用效果优于现有方案

Clin Gastroenterol H:多普勒探头在非静脉曲张上消化道出血治疗中成本更低且更有效

由此可见,在成本效益分析中,研究人员发现DPE相比于TEA治疗非静脉曲张性上消化道出血患者高风险病变在经济效益上更占优势;DPE成本更低,效率更高。

JGH OPEN: 给食管静脉曲张患者放置肠管出现消化道出血的风险因素

食管静脉曲张(EV)患者由于易引发静脉曲张破裂出血,因此应谨慎置入肠管(ET)进行胃肠减压或相关治疗。目前患有EV的患者胃肠道出血(GIB)发生率和预测因素数据有限。

JAMA:多种抗凝药上消化道出血风险比较研究

研究认为,接受利伐沙班抗凝药物的患者其上消化道出血风险最高,阿哌沙班最低,抗凝药与PPI联合用药可降低抗凝药物上消化道出血风险

Dig Liver Dis: 医疗环境与急性上消化道出血的存活率有关

目前关于医疗环境对急性上消化道出血患者的生存率影响的数据有限。本项研究旨在识别能为急性上消化道出血患者提供最佳生存的组织和护理环境。

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