基于逆概率加权法分析急诊救治通道对上消化道出血患者治疗效果的影响

Analysis of the impact of emergency treatment channel on the curative effect of patients with upper gastrointestinal bleeding based on the inverse probability of treatment weighting

目的通过倾向性评分逆概率加权法(IPTW)探讨上消化道出血急诊救治通道对急性上消化道出血(AUGIB)患者的临床治疗效果。方法采用回顾性研究方法。纳入2018年1月至2021年12月贵阳市第一人民医院收治的299例AUGIB患者的临床信息,选择急诊救治通道建立前(2018年1月至2019年12月)收治的AUGIB患者为常规组(152例),以急诊救治通道建立后(2020年1月至2021年12月)收治的AUGIB患者为通道组(147例)。采用IPTW对多个混杂变量性别、年龄、既往基础疾病、非甾体抗炎药(NSAID)服用史、个人史、格拉斯哥Blatchford评分(GBS)、不同出血病因等进行平衡,经IPTW处理后实现混杂变量在组间的一致分布。比较常规组与通道组临床治疗效果的差异,包括止血时间、出血复发率、输血量、住院时间、住院费用、重症监护病房(ICU)转入率、病死率等。结果经IPTW后,混杂变量在组间均衡效果好。通道组止血时间〔h:7.90(5.36,11.42)比9.92(6.25,18.15)〕、出血复发率〔23.1%(34/147)比40.1%(61/152)〕、住院时间〔d:8.00(7.00,10.34)比9.00(7.00,13.00)〕、ICU转入率〔8.8%(13/147)比17.7%(27/152)〕、病死率〔0.7%(1/147)比4.5%(7/152)〕均明显低于常规组(均P<0.05);通道组和常规组输血量、住院费用比较差异均无统计学意义〔输血量(U):2(0,4)比2(0,4),住院费用(万元):1.35(1.03,2.00)比1.16(0.71,2.29),均P>0.05〕。结论该急诊救治通道能降低AUGIB患者的出血复发率、ICU转入率及病死率,缩短止血时间和住院时间,具有很好的治疗效果。

Objective To explore the clinical effectiveness of emergency upper gastrointestinal bleeding channel for patients with acute upper gastrointestinal bleeding(AUGIB)by the inverse probability of treatment weighted(IPTW)method.Methods A retrospective study method was used.The clinical information was collected on 299 AUGIB patients who belonged to the First People's Hospital of Guiyang,where they were admitted from January 2018 to December 2021.AUGIB patients admitted before the establishment of emergency treatment channel(from January 2018 to December 2019)were selected as the routinel group(152 cases),while AUGIB patients admitted after the establishment of emergency treatment channel(from January 2020 to December 2021)were selected as the channel group(147 cases).IPTW was used to balance multiple confounding variables[gender,age,history of previous underlying diseases,history of non-steroidal anti-inflammatory drug(NSAID)administration,personal history,Glasgow-Blatchford score(GBS),different bleeding etiologies,etc.],a consistent distribution of confounding variables among the groups was achieved after IPTW treatment.The difference of clinical treatment effects between the routine group and the channel group was performed,including time to hemostasis,recurrent bleeding rate,volume of blood transfusions,length of hospital stay,hospitalization cost,intensive care unit(ICU)transfer rate,and mortality etc.were compared.Results After IPTW,the confounding variables were well-balanced between groups.The time to hemostasis[hours:7.90(5.36,11.42)vs.9.92(6.25,18.15)],recurrent bleeding rate[23.1%(34/147)vs.40.1%(61/152)],length of hospital stay[days:8.00(7.00,10.34)vs.9.00(7.00,13.00)],ICU transfer rate[8.8%(13/147)vs.17.7%(27/152)],and mortality[0.7%(1/147)vs.4.5%(7/152)]in channel group were significantly lower than those in the routine group(all P<0.05).There were no significant difference in transfusions volume and hospital cost between channel group and routine group[transfusions volume(U):2(0,4)vs.2(0,4),hospitalization cost(ten thousand yuan):1.35(1.03,2.00)vs.1.16(0.71,2.29),both P>0.05].Conclusion The emergency treatment channel can reduce the recurrent bleeding rate,ICU transfer rate,and mortality rate,shorten the time of hemostasis and length of hospital stay,and has a good treatment effect.