Blatchford评分系统对老年人非静脉曲张性上消化道出血的临床意义  

Prognostic value of Blatchford score systems in elderly patients with non-variceal upper gastrointestinal bleeding

作　　者：曹鸿霞[1] 章礼久[1] 

机构地区：[1]安徽医科大学第二附属医院消化内科,安徽省合肥市230601

出　　处：《实用老年医学》2016年第8期644-647,共4页Practical Geriatrics

摘　　要：目的探讨Blatchford评分系统对老年人非静脉曲张性上消化道出血(NUGIB)再出血、输血、平均住院日、介入和内镜干预措施及死亡的预测价值。方法收集2014年10月至2015年9月我院消化内科住院的NUGIB患者192例,采用Blatchford评分对所有入选者进行评分及危险程度分级,将其中86例老年患者和106例非老年患者进行比较,运用受试者特征(ROC)曲线来评估Blatchford评分对NUGIB患者再出血、输血、死亡等的预测价值。结果老年组患者再出血率为13.95%(12/86),高于非老年组的2.83%(3/106),差异有统计学意义(P<0.05)。预测老年组和非老年组输血率分别为39.53%(34/86)和11.3%(12/106),差异有统计学意义(P<0.05)。以Blatchford评分=6分为临界点,预测老年组和非老年组再出血的灵敏度分别为91.7%和100%,特异度分别为78.4%和71.8%。老年组和非老年组输血灵敏度分别为97.1%和100%,特异度分别为69.2%和65.1%。Blatchford评分对老年组输血、再出血有较好预测价值,老年组和非老年组再出血曲线下面积(AUC)分别为0.676和0.673,2组输血AUC分别为0.738和0.737,老年组死亡AUC为0.813。结论 Blatchford评分系统对老年组NUGIB患者输血及死亡有较高的预测价值,对2组患者再出血无预测价值。可将6分作为截点判断低危组和高危组人群。Objective To explore the application of Blatchford score systems for assessing the risk of rebleeding, blood transfusion, average length of stay and death in elderly patients with non-variceal upper gastrointestinal bleeding （NUGIB）. Methods Eighty-six elderly patients and 106 non-elderly patients with NUGIB enrolled from October 2014 to September 2015 were graded by Blatchford scoring systems, receiver operating characteristic （ROC） curve of Blatchford score was used to evaluate blood transfusion, rebleeding, intervention and death. Results The rebleeding rate （ 13.95% vs 2. 83% ） and blood transfusion rate （39.53% vs 21.7% ） was higher in eldery patients than that in non-elderly patients （P〈0. 05）. The sensitivity of Blatchford score system with score 6 as the cut-off point for assessing of rebleeding rate was 91.7% or 100%, and the specificity was 78.4% or 71.8% in elderly or non-elderly patients with NUGIB, respectively. The sensitivity of Blatchford risk scoring system with score 6 as the cut-off point for assessing of blood transfusion rate was 97. 1% or 100%, and the specificity was 69.2% or 65. 1%in elderyly or non-elderly patients with NUGIB, respectively. The AUC of Blatchford score for the assessment of rebleeding was 0. 676 or 0. 673 respectively and the AUC for blood trans- fusion was 0. 738 or 0. 737 in elderyly or non-elderly patients with NUG1B respectively. The AUC of Blatchford score for as- sessment of the death in elderly patients was 0. 813. Conclusions Blatchford score system has good prognostic value on blood transfusion and death in elderly patients with NUGIB, but has no value for prediction of rebleeding in the two groups. Score 6 can be regarded as the cut-off point to judge the low or high risk of rebleeding in elderly patients with NUGIB.

关 键 词：Blatchford评分系统 非静脉曲张性上消化道出血 危险性评估 

分 类 号：R573.2[医药卫生—消化系统]