Risk factors of rebleeding and its clinical significance in 1 417 cases of acute non-variceal upper gastrointestinal bleeding
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摘要: 目的 研究导致急性非静脉曲张性上消化道出血(acute non-variceal upper gastrointestinal bleeding,ANVUGIB)患者再出血的危险因素,以及Rockall、Blatchford评分系统对预测患者再出血风险的临床价值。 方法 收集符合入选条件的1 417例ANVUGIB患者的临床资料,根据转归分为好转组和再出血组,运用单因素分析及多因素Logistic多元回归分析,比较分析2组患者的一般情况、出血表现、病前合并疾病、发病后并发症、内镜诊断与治疗、药物使用等因素的差异以及Rockall、Blatchford评分系统的预测价值。 结果 单因素分析显示2组患者在发病年龄、心率、休克指数、尿素氮水平,是否合并心脏疾病、肝脏疾病和肿瘤播散,以及是否并发休克、贫血间的差异具有统计学意义(均为P<0.05),Rockall及Blatchford评分均有预测再出血的价值(P<0.05);多因素分析则显示高休克指数、合并肝衰或肝疾病及高Rockall评分是影响ANVUGIB患者再出血的独立危险因素(均为P<0.05)。 结论 在ANVUGIB患者中,高休克指数和合并肝衰或肝疾病者具有更高的再出血风险,Rockall评分系统具有预测再出血的临床价值。
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关键词:
- 急性非静脉曲张性上消化道出血 /
- 再出血 /
- 危险因素 /
- 临床意义
Abstract: Objective To investigate the risk factors of rebleeding in patients with acute non-variceal upper gastrointestinal bleeding(ANVUGIB),and the predicting value of Blatchford and Rockall scoring system. Methods Qualified data of 1 417 patients with ANVUGIB admitted to Tongji Hospital between 2008 and 2012 were collected and scored with Blatchford and Rockall scoring system.According to the outcomes,they were divided into two groups,which including improved group and rebleeding group.Univariate analysis and multivariate logistic regression models were used to evaluate the data of patients’ general state,bleeding performance,co-morbidity,complication,endoscopic situation,usage of drugs and predictive value of risk score. Results Univariate analysis showed that there were the statistically significant between age,heart rate,shock index(SI),blood urea nitrogen(BUN) concentration,ratio of co-morbiditiy of heart disease,hepatic disease,tumor spread,shock anemia(P<0.05),and both of Rockall and Blatchford system have the value on predicting rebleeding(P<0.05).Multivariate logistic regression showed high SI,co-morbiditiy of hepatic failure or hepatic disease and high Rockall score are the independent risk factors for rebleeding(P<0.05). Conclusion The patients with high SI,co-morbiditiy of hepatic failure or hepatic disease and high Rockall score are more likely to suffer rebleeding.
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