实验室指标联合Blatchford评分对急性上消化道出血内镜介入治疗后再出血的预测价值

Value of laboratory indexes combined with Blatchford score in predicting rebleeding in patients with acute nonvariceal uppergastrointestinal bleeding after receiveing endoscopic interventional therapy

目的评价实验室指标联合Blatchford评分对急性非静脉曲张性上消化道出血(ANVUGIB)内镜介入治疗止血后再出血的预测价值。方法回顾性分析2010年3月至2015年5月于我院首次内镜治疗止血成功的194例ANVUGIB患者的临床资料,按照7 d内是否再出血分为再出血组(48例)与非出血组(146例),比较两组血红蛋白(HGB)、尿素氮(BUN)、血小板计数(PLT)、白蛋白(ALB)、休克指数、发病至输血时间、心率、血压、Blatchford评分结果及既往史等资料,筛选影响急性上消化道出血内镜介入后再出血的相关因素,分析实验室指标联合Blatchford评分对ANVUGIB内镜介入止血后再出血的预测价值。结果 1两组患者年龄、吸烟史、饮酒史、ALB、PLT、发病至输血时间、呕血、晕厥、多脏器功能衰竭对比差异无统计学意义(P>0.05),再出血组心率、BUN、输血率、休克指数、Blatchford评分中高危比例、黑便症状所占比例、并发失血性休克比例均高于非出血组(P<0.05),其HGB、收缩压均低于非出血组(P<0.05);2单项指标中,以Blatchford评分预测准确率最高(79.17%),联合预测以血BUN+HGB+Blatchford评分预测准确率最高(95.83%);3多因素分析发现,BUN>6.5mmo L、HGB<90g/L、收缩压<109mm Hg、Blatchford评分≥6分、休克指数>0.7均为首次内镜止血成功后再出血的独立危险因素(P<0.05)。结论 BUN、HGB联合Blatchford评分对ANVUGIB患者首次内镜介入治疗止血后再出血发生率有较高的预测价值,BUN、HGB、收缩压、休克指数、Blatchford评分均与ANVUGIB患者首次内镜止血后再出血发生密切相关。

Objective To evaluate the value of laboratory indexes combined with Blatchford score in predicting rebleeding in patients with acute nonvariceal uppergastrointestinal bleeding（ANVUGIB） after receiving endoscopic interventional therapy.Methods The clinical data of 194 ANVUGIB patients who were successfully treated by endoscopic therapy in our hospital between March 2010 and May 2015 were analyzed.According to whether there was rebleeding within 7d,they were divided into rebleeding group（n = 48） and non bleeding group（n = 146）.Hemoglobin（HGB）,blood urea nitrogen（BUN）,platelet count（PLT）,albumin（ALB）,shock index,time from onset to transfusion,heart rate,blood pressure,Blatchford scoring results and past medical history,etc.were compared between the two groups.The related factors for rebleeding after endoscopic intervention of ANVUGIB were screened.The value of laboratory indexes combined with Blatchford score in predicting rebleeding after endoscopic interventional therapy for ANVUGIB was analyzed.Results 1There were no significant differences in age,smoking history,drinking history,ALB,PLT,time from onset to transfusion,hematemesis,syncope and multiple organ failure between the two groups（P〈0.05）.The rebleeding rate,blood BUN,blood transfusion rate,shock index,proportion of high risk in Blatchford score,proportion of melena,and proportion of being complicated with hemorrhagic shock in rebleeding group were higher than those in non bleeding group（P〈0.05）.HGB and systolic blood pressure were lower than those of non bleeding group（P〈0.05）; 2In single indexes,the predictive accuracy rate of Blatchford score was the highest（79.17%）,and the predictive accuracy rate of blood BUN＋HGB＋Blatchford score was the highest（95.83%） in combined prediction; 3Multivariate analysis revealed that blood BUN 6.5mmo L,blood HGB 90g/L,systolic pressure 109 mm Hg,Blatchford score ≥ 6 points and shock index 0.7 were the independent risk factors of rebleeding after successful endoscopic hemostasis（P〈0.05）.Conclusion BUN and HGB combined with Blatchford score are of higher value in predicting rebleeding in ANVUGIB patients after endoscopic interventional therapy.BUN,HGB,systolic blood pressure,shock index and Blatchford score are closely related to rebleeding in patients after endoscopic hemostasis.