Blatchford评分对非静脉曲张性上消化道出血的临床意义探讨

Clinical significance of Blatchford score in non-variceal upper gastrointestinal bleeding

目的探讨Blatchford评分在非静脉曲张性上消化道出血中的临床应用价值。方法选取2017年9月—2018年3月期间我院收治的非静脉曲张性上消化道出血患者140例,根据患者年龄分为老年组(≥60岁)和非老年组(<60岁),利用受试者工作特征(ROC)曲线评估Blatchford评分对非静脉曲张性上消化道出血输血、再出血、干预及死亡等情况的预测价值。结果 2组患者住院时间对比差异无统计学意义(P>0.05);以Blatchford评分为6分为临界点,老年组输血的灵敏度及特异度分别为96.67%(29/30)、67.50%(27/40),非老年组输血的灵敏度及特异度分别为100.00%(15/15)、65.45%(36/55);老年组再出血的灵敏度及特异度分别为90.00%(9/10)、78.33%(47/60),非老年组再出血的灵敏度及特异度分别100.00%(2/2)、72.06%(49/68);老年组输血、再出血情况发生率(42.86%,14.29%)较非老年组(21.43%,2.86%)高,差异有统计学意义(P<0.05);老年高危组、非老年高危组输血发生率均较老年低危组高,差异有统计学意义(P<0.05);老年组与非老年组中高危组与低危组再出血情况相比,差异无统计学意义(P>0.05);老年高危组中有1例患者需要采取干预措施,死亡2例,老年低危组与非老年高危及低危组中均无需要干预及死亡患者。结论 Blatchford评分在非静脉曲张性上消化道出血中具有较高的应用价值,可有效预测患者的输血情况及死亡情况,且以6分为临界点可有效区分高危患者及低危患者。

Objective To investigate the application value of Blatchford score in non-variceal upper gastrointestinal bleeding（UGIB）. Methods 140 UGIB patients in our hospital from September 2017 to March 2018 were selected,and they were divided into senile group（aged≥60）and non-senile group（aged60）by patients＇ age.The receiver operating characteristic curve（ROC） of Blatchford score was used to evaluate blood transfusion,rebleeding,intervention and death of UGIB. Results There was no statistical difference in the hospital stays between the two groups（P〈0.05）. The Blatchford score 6 was taken as the cut-off point,the sensitivity and specificity of blood transfusion in senile group were 96.67%（29/30） and 67.50%（27/40）,the sensitivity and specificity of blood transfusion in non-senile group were 100.00%（15/15） and 65.45%（36/55）. The sensitivity and specificity of rebleeding in senile group were 90.00%（9/10）and 78.33%（47/60）, the sensitivity and specificity of rebleeding in non-senile group were 100.00%（2/2）and 72.06%（49/68）. The incidence of blood transfusion and rebleeding in senile group（42.86%,14.29%）were higher than non-senile group（21.43%,2.86%）（P〈0.05）. The incidence of blood transfusion in senile high-risk group and non-senile high-risk group was higher than that in senile low-risk group（P〈0.05）. There was no statistical difference in the rebleeding among high-risk group and low-risk group in senile group and non-senile middle（P〉0.05）. There were 1 case needed intervention and 2 cases of death in senile high-risk group. There were no patients needed intervention and dead cases in senile low-risk group,non-senile high-risk group and low-risk group. Conclusion The Blatchford score has higher application value in UGIB,it can effectively predict patients＇ blood transfusion and death, and the Blatchford score 6 as the cut-off point can judge the high or low risk patients.