Rockall评分指导治疗急性上消化道出血对患者预后影响

Prognosis effect of Rockall scoring system on the treatment of acute upper gastrointestinal hemorrhage patients.

目的探讨分析急性上消化道出血患者应用Rockall评分指导治疗对患者预后影响。方法以2013年8月至2015年12月间,我院就诊的205例急门诊上消化道出血患者为研究对象,按照Rockall评分标准收集患者相关的临床资料,比较分析再出血组和非再出血、死亡组和生存组患者的PRS、CRS评分情况;采用多因素非条件Logistic回归分析分析影响再出血的危险因素;采用ROC曲线对Rockall评分的预测价值进行评估。结果 205例患者再出血发生率6.83%,死亡率3.41%;再出血组患者的PRS与CRS评分明显高于非再出血组患者,死亡组患者的PRS与CRS评分明显高于生存组患者,差异有统计学意义(P<0.05);年龄≥60岁、出血量过多、休克、喷血、渗血、Hb<90g/L、单一内镜治疗及支持治疗缺乏为急性上消化道出血患者再出血的危险因素,差异有统计学意义(P<0.05);采用Rockall评分系统预测再出血患者的ROC曲线下面积为0.787,其95%可信区间为0.726-0.848(P<0.05);预测死亡患者的ROC曲线下面积为0.752,其95%可信区间为0.678-0.825(P<0.05)。结论应用Rockall评分系统在指导急性上消化道出血治疗与提高患者预后具有较高的临床应用价值;各种危险因素的患者其发生再出血的危险性更高,在临床治疗干预时,应该给予针对性的处理措施。

Objective To explore the prognosis effect of Rockall scoring system on the treatment of acute upper gastrointestinal hemorrhage patients. Methods The clinical data of 205 acute upper gastrointestinal hemorrhage patients from August 2013 to December 2015 in our hospital were collected as the research object,according to Rockall scoring criteria. The PRS score and CRS score of rebleeding group and non rebleeding group,death group and survival group were compared,respectively. Multivariate non conditional Logistic regression analysis was used to analyze the risk factors of rebleeding. The ROC curve was used to evaluate the predictive value of Rockall score. Results The rebleeding rate and the death rate of 205 patients were 6. 83% and 3.41%,and the PRS and CRS score of rebleeding group and death group were significantly higher than that of non rebleeding group and survival group（ P〈0. 05）.Age（ ≥60）,excessive bleeding,shock,spurting bleeding,oozing bleeding,Hb 〈90 g / L,single endoscopic therapy and supportive treatment lack were risk factors for acute upper gastrointestinal hemorrhage patients（ P〈0. 05）. The area under the ROC curve of Rockall score for the predicting of rebleeding and the death were 0.787（95% CI 0. 726-0.848,P = 0.001 〈0.05） and 0.752（ 95% CI 0.678- 0.825,P = 0.001〈0.05） respectively. Conclusion The application of Rockall scoring system has a high clinical value in the treatment of upper gastrointestinal hemorrhage and the improvement of prognosis. The patients with old age,excessive bleeding,shock,spurting bleeding,oozing bleeding,low hemoglobin,single endoscopic therapy and supportive treatment lack have higher risk when rebleeding,and should be given targeted measures in the clinical treatment.