非静脉曲张性消化道出血患者风险评估工具的比较研究  

Comparative study of risk assessment tools for patients with non-varicose gastrointestinal bleeding

作　　者：江秋霞 刘金凤 阳凤 刘阿兰 王常凤 Jiang Qiuxia;Liu Jinfeng;Yang Feng;Liu Alan;Wang Changfeng(Department of Gastroenterology,the First Affiliated Hospital of University of Science and Technology of China,Hefei 230001,China)

机构地区：[1]中国科学技术大学附属第一医院消化内科,合肥230001

出　　处：《中华现代护理杂志》2020年第24期3261-3267,共7页Chinese Journal of Modern Nursing

基　　金：军事医学创新工程(18CXZ040)。

摘　　要：目的:比较Blatchford入院危险性积分(Glascow-Blatchford Scoring System,GBS)、修正版GBS(Modified Glascow-Blatchford Scoring System,mGBS)评分系统对非静脉曲张性消化道出血患者临床干预及预后的评估价值。方法:采用便利抽样法,回顾性分析2017年1月—2018年5月收治于安徽省某三级甲等医院的254例非静脉曲张性消化道出血患者,计算所有患者的GBS和修正版GBS得分,比较两种评分系统预测患者住院期间再出血率、输血、内镜干预、患者死亡及转ICU率的价值。结果:GBS评分系统在非静脉曲张消化道出血患者输血、再出血、死亡和转ICU评估的ROC曲线下面积(AUC)分别为0.761、0.714、0.865、0.829,mGBS评分系统在非静脉曲张消化道出血患者输血、再出血、死亡和转ICU评估的AUC分别为0.753、0.718、0.871、0.792,两种评分系统均具有良好的预测能力;GBS评分系统对内镜下干预预测的AUC为0.540,mGBS评分系统统对内镜下干预预测的AUC为0.542,具有较低的预测价值。GBS评分系统输血、再出血、死亡和转ICU的截断点分别为8、11、12、11,mGBS评分系统输血、再出血、死亡和转ICU的截断点分别为7、8、10、11,最佳截断点均随着疾病严重程度的增加而增大,两种评分系统比较差异无统计学意义(P>0.05)。结论:两种评分系统均能较好地预测非静脉曲张性消化道出血患者的疾病干预需求及预后,推荐临床使用更为简便的修正版GBS评分系统。Objective To compare the evaluation value of Glascow-Scoring Scoring System(GBS)and Modified Glascow-Scoring System(mGBS)for clinical intervention and prognosis of patients with non-varicose gastrointestinal bleeding.Methods The convenient sampling method was used to retrospectively analyze 254 patients with non-varicose gastrointestinal bleeding who were admitted to a Class IE Grade A hospital in Anhui province from January 2017 to May 2018,and GBS and revised GBS scores of all patients were calculated.The value of the two scoring systems in predicting of rebleeding rate during hospitalization,blood transfusion,endoscopic intervention,deaths of patients and the rate of patients transferring to ICU.Results Area under the ROC curve(AUC)of GBS scoring system for blood transfusion,rebleeding,death and ICU transfer in patients with non-varicose gastrointestinal bleeding were 0.761,0.714,0.865 and 0.829,respectively.AUC of mGBS scoring system for blood transfusion,rebleeding,death and ICU transfer in non-varicose gastrointestinal bleeding patients were 0.753,0.718,0.871 and 0.792,respectively.Both scoring systems had good predictive ability.The predicted AUC of GBS scoring system for endoscopic intervention was 0.540,and that of mGBS scoring system was 0.542,showing a low predictive value.The cut-off points for blood transfusion,rehleeding,death and transfer to ICU were respectively 8,11,12,and 11 for the GBS scoring system,and those were respectively 7,8,10,and 11 for mGBS scoring system.The optimal cutoff point increased with the increase of disease severity,and there was no statistically significant difference between the two scoring systems(P>0.05).Conclusions Both scoring systems can better predict the disease intervention needs and prognosis of patients with non-varicose gastrointestinal bleeding.It is recommended to use the simpler and modified GBS scoring system in clinical practice.

关 键 词：非静脉曲张性消化道出血 评分系统 风险评估 

分 类 号：R573.2[医药卫生—消化系统]