Predictive utility of the Rockall scoring system in patients suffering from acute nonvariceal upper gastrointestinal hemorrhage

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)represents a sig-nificant clinical challenge due to its unpredictability and potentially severe out-comes.The Rockall risk score has emerged as a critical tool for prognostic asse-ssment in patients with ANVUGIB,aiding in the prediction of rebleeding and mo-rtality.However,its applicability and accuracy in the Chinese population remain understudied.AIM To assess the prognostic value of the Rockall risk score in a Chinese cohort of patients with ANVUGIB.METHODS A retrospective analysis of 168 ANVUGIB patients’medical records was condu-cted.The study employed statistical tests,including the t-test,χ2 test,spearman correlation,and receiver operating characteristic(ROC)analysis,to assess the re-lationship between the Rockall score and clinical outcomes,specifically focusing on rebleeding events within 3 months post-assessment.RESULTS Significant associations were found between the Rockall score and various clinical outcomes.High Rockall scores were significantly associated with rebleeding events(r=0.735,R2=0.541,P<0.001)and strongly positively correlated with adverse outcomes.Low hemoglobin levels(t=2.843,P=0.005),high international normalized ratio(t=3.710,P<0.001),active bleeding during endoscopy(χ2=7.950,P=0.005),large ulcer size(t=6.348,P<0.001),and requiring blood transfusion(χ2=6.381,P=0.012)were all significantly associated with rebleeding events.Furthermore,differences in treatment and management strategies were identified between patients with and without rebleeding events.ROC analysis indicated the excellent discriminative power(sensitivity:0.914;specificity:0.816;area under the curve:0.933;Youden index:0.730)of the Rockall score in predicting rebleeding events within 3 months.CONCLUSION This study provides valuable insights into the prognostic value of the Rockall risk score for ANVUGIB in the Chinese population.The results underscore the potential of the Rockall score as an effective tool for risk strati-fication and prognostication,with implications for guiding risk-appropriate management strategies and optimizing care for patients with ANVUGIB.

巴曲酶联合洛赛克治疗急性上消化道出血的效果及对患者血小板功能的影响

目的 研究巴曲酶联合洛赛克治疗急性上消化道出血的效果及对患者血小板功能的影响。方法 选取2017年10月至2018年10月锦州市第二医院收治的急性上消化道出血的患者100例,按照数字表法将所有患者随机分为单药治疗组和联合治疗组,各50例。单药治疗组患者使用洛赛克进行治疗,联合治疗组在单药治疗组的基础上联合巴曲酶进行治疗。对两组患者治疗后止血效果及治疗前后凝血功能指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(D-D)、纤维蛋白原(FIB)及血小板功能指标血小板数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、血小板聚集率(MAR)进行检测,统计治疗效果和治疗过程中不良反应发生情况,并做组间比较。结果 联合治疗组的止血、血压稳定、腹痛缓解时间均短于单药治疗组,胃管引流量低于单药治疗组(P<0.05)。治疗前两组PT、APTT、FIB、D-D、PDW、MPV、PLT、MAR水平比较,无统计学差异(P>0.05);治疗后两组PT、APTT、D-D水平均低于治疗前,FIB、PDW、MPV、PLT、MAR水平均高于治疗前,且治疗后联合治疗组PT、APTT、D-D水平低于单药治疗组,FIB、PDW、MPV、PLT、MAR水平高于单药治疗组(P<0.05)。联合治疗组的治疗总有效率为96.00%,显著高于单药治疗组的82.00%(P<0.05)。联合治疗组患者治疗过程中总不良反应发生率低于单药治疗组(P<0.05)。结论 运用巴曲酶联合洛赛克对急性上消化道出血患者进行治疗,能够有效改善患者的凝血功能和血小板功能,改善患者出血症状,且不良反应较少,安全性较高。

Rockall评分系统在急性非静脉曲张性上消化道出血患者中的应用

目的探讨Rockall危险积分在急性非静脉曲张性上消化道出血患者中的应用，评估其对死亡及再出血的预测能力准确性。方法回顾性分析上海浦东医院消化科ANVUGIB患者474例，按年龄段分为〈40岁组、40～59岁组、60～79岁组和／〉80岁组，应用Rockall评分系统进行评分，采用受试者工作特征曲线（ROC）下面积（AUC）评估其对ANVUGIB再出血及死亡的预测能力。结果474例ANVUGIB患者中男性与女性之比约为2．36：1，死亡22例（4．64％），再出血54例（11．39％）。Rockalli~分系统预测死亡的AUC=0．849（P〈0．05），预测再出血的AUC=0．675（P〉0．05）。各组再出血率分别为10％、7．53％、12．58％、19．58％。Rockall评分系统评估各组再出血率AUC分别为0．610、0．740、0．632、0．727。各组死亡率分别为0％、5．48％、2．65％、10．3％。结论Rockall评分系统对ANVUGIB死亡的预测能力良好。Rockall评分系统对40～59岁组、≥80岁组ANVUGIB患者再出血预测价值较高。