AIMS65和Glasgow-Blatchford评分系统在急性上消化道出血中的临床研究

发布时间：2018-04-19 15:09

本文选题：AIMS65评分系统 + Glasgow-Blatchford评分系统　；参考：《郑州大学》2017年硕士论文

【摘要】：背景急性上消化道出血(acute upper gastrointestinal bleeding AUGIB)是临床常见的急危重症,起病急、病情发展快,根据病情的严重程度可以导致不同的后果,轻者仅表现为头晕、乏力、晕厥等不典型症状,病情危重者可导致周围循环衰竭、休克,甚至危及生命。如何根据患者的临床表现、实验室检查结果迅速、准确地制定合理的治疗方案、预测预后是临床医生关注的焦点。目的探讨AIMS65和Glasgow-Blatchford评分系统(GBS)对AUGIB患者临床干预(输血以及转ICU治疗)及预后(再出血和死亡)的预测价值。方法记录郑州大学第一附属医院2015年1月-2016年7月收治的339例符合研究标准及资料完整的AUGIB临床资料。计算所有入院患者AIMS65和GBS积分,比较不同分值患者的临床干预及预后情况。计算两种评分系统的受试者工作曲线下面积(area under the receiver operating characteristic curve,AUC),评估其对AUGIB患者临床干预及不同预后的预测价值。根据约登指数,比较两种危险评估系统对不同预后及临床干预的最佳临界值。结果(1)AIMS65随着分数的增高,输血率、转ICU率、再出血率、病死率风险增高。(2)GBS随着分数的增高,输血率、转ICU率、再出血率、病死率风险增高。(3)GBS对输血率的预测价值高于AIMS65评分系统(AUC 0.800 vs 0.727P0.05);GBS对再出血率的预测价值高于AIMS65评分系统(AUC 0.713 vs 0.698P0.05);AIMS65评分系统对病死率的预测价值高于GBS(AUC 0.859 vs 0.813P0.05);GBS对转ICU率的预测价值与AIMS65评分系统相似(AUC 0.832 vs0.833 P0.05)。(4)AIMS65评分系统对输血、转ICU、再出血、死亡预测的最佳临界值是2分。GBS对输血的最佳临界值为11分,死亡和转ICU的最佳临界值为14分,再出血预测的最佳临界值是13分。结论1.AIMS65评分系统在预测病死率方面优于GBS,但在预测输血率以及再出血率方面GBS优于AIMS65评分系统,在预测转ICU率方面,两者的准确性相似。2.AIMS65对于临床干预及不同预后的最佳临界值为2分。
[Abstract]:Background Acute upper gastrointestinal bleeding AUGIBB (acute upper gastrointestinal bleeding AUGIBB) is a common clinical acute and critical disease, with rapid onset and rapid development. According to the severity of the disease, it can lead to different consequences. The mild patients only show atypical symptoms, such as dizziness, fatigue, syncope and so on.Critical patients can cause peripheral circulatory failure, shock, and even life-threatening.It is the focus of clinicians how to make reasonable treatment plan and predict prognosis according to the clinical manifestation and the results of laboratory examination.Objective to evaluate the predictive value of AIMS65 and Glasgow-Blatchford scoring system in clinical intervention (blood transfusion and conversion to ICU treatment) and prognosis (rebleeding and death) in AUGIB patients.Methods the clinical data of 339 AUGIB patients admitted to the first affiliated Hospital of Zhengzhou University from January 2015 to July 2016 were recorded.The AIMS65 and GBS scores of all patients were calculated, and the clinical intervention and prognosis of patients with different scores were compared.The area under the operating curve of under the receiver operating characteristic was calculated to evaluate its predictive value for clinical intervention and different prognosis in patients with AUGIB.According to the Jorden index, the optimal critical values of two risk assessment systems for different prognosis and clinical intervention were compared.Results with the increase of the score, the blood transfusion rate, the conversion rate of ICU, the rate of rebleeding and the risk of death were increased. With the increase of the fraction, the blood transfusion rate, the rate of conversion to ICU, the rate of rebleeding, and the rate of rebleeding were increased with the increase of the score of AIMS65.The predictive value of GBS to blood transfusion rate is higher than that of AIMS65 scoring system (AUC 0.800 vs 0.727 P0.05GBS) in predicting the rate of re-bleeding. It is higher than that of AIMS65 scoring system (AUC 0.713 vs 0.698P0.05% AIMS65) in predicting mortality rate. It is higher than that of GBS(AUC 0.859 vs 0.813P0.05GBS in predicting mortality.The predictive value of ICU rate was similar to that of AIMS65 scoring system.The best critical value for ICU, rebleeding, and death prediction was 11 for blood transfusion, 14 for death and ICU, and 13 for rebleeding.Conclusion 1.AIMS65 scoring system is superior to GBS in predicting mortality rate, but GBS is superior to AIMS65 scoring system in predicting blood transfusion rate and rebleeding rate, and in predicting ICU rate.The accuracy of AIMS65 was similar. 2. The best critical value of AIMS65 for clinical intervention and different prognosis was 2 points.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R573.2

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