Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis

BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%.

Endoscopic hemostasis techniques for upper gastrointestinal hemorrhage: A review

Upper gastrointestinal hemorrhage (UGIH) is an urgent disease that is often encountered in daily medical practice. Endoscopic hemostasis is currently indispensable for the treatment of UGIH. Initially, when UGIH is suspected, a cause of UGIH is presumed from the medical interview and physical findings. After ample primary treatment, urgent endoscopy is performed. Many methods of endoscopic hemostasis are in wide use, including hemoclip, injection and thermo-coagulation methods. Although UGIH develops from a wide variety of diseases, such as esophageal varices and gastric and duodenal ulcer, hemostasis is almost always possible. Identification of the causative diseases, primary treatment and characteristic features of endoscopic hemostasis are needed to allow appropriate treatment.

Urgent Endoscopy in Nonvariceal Upper Gastrointestinal Hemorrhage:A Retrospective Analysis

Objective:The role of urgent endoscopy in nonvariceal upper gastrointestinal hemorrhage(NVUGIH)remains controversial.We designed a retrospective study to compare the outcomes between urgent endoscopy(within 12 h)and non-urgent endoscopy for patients with NVUGIH.Methods:A total of 540 hospitalized patients with NVUGIH were included in our study.Patients who received endoscopy within 12 h or after 12 h were divided into two groups,the urgent and non-urgent endoscopy groups,respectively.The clinical outcomes including rebleeding,mortality,endoscopic re-intervention,need for emergency surgery and interventional radiotherapy were compared between the groups.Patients with Glasgow-Blatchford scores(GBS)<12 and>12 were defined as the lower-and high-risk groups,respectively,and the predictors of rebleeding and mortality in both groups were analyzed individually.Results:Patients with NVUGIH in the urgent endoscopy group had a higher rate of rebleeding(27.6%vs.16.9%,P=0.003)and blood transfusion(73.2%vs.55.5%,P<0.001)than those in the non-urgent endoscopy group,while the mortality and the length of hospitalization were not significantly different between the groups(P>0.05).For lower-risk patients,urgent endoscopy was independently associated with a higher likelihood of rebleeding(adjusted OR:1.73,95%CI:1.03-2.88),while it was not associated with in-hospital mortality.However,the urgent need for endoscopy was not associated with rebleeding and in-hospital mortality in high-risk patients.Conclusion:Endoscopy within 12 h did not provide any advantage in the outcomes of patients with NVUGIH,and may even lead to an increased rebleeding rate in lower-risk patients.

Upper gastrointestinal hemorrhage caused by superwarfarin poisoning

Superwarfarins are a class of rodenticides. Gastrointestinal hemorrhage is a fatal complication of superwarfarin poisoning, requiring immediate treatment. Here, we report a 55-year-old woman with tardive upper gastrointestinal hemorrhage caused by superwarfarin poisoning after endoscopic cold mucosal biopsy.

Pseudoxantoma elasticum,as a repetitive upper gastrointestinal hemorrhage cause in a pregnant woman

Pseudoxantoma elasticum is a rare, hereditary, multisystemic disease affecting the skin, eye, and cardiovascular system. A twenty-eight-year-old female has presented to emergency unit with the complaint of gastrointestinal hemorrhage. This patient, who had been monitored in the gastroenterology clinic more than 10 times in the past 8 years, noted a repetitive hemorrhage during her previous pregnancy in her history. The examination of the patient revealed the following signs and symptoms： atrophy in the epithelium of the retina pigment; typical angioid streaks and peau d＇orange finding in the fundus; thinning of the retinal nerve fiber in OCT （optic coherence tomography）; bilateral and reticular papillary lesions with yellowish- color in the neck region （plucked chicken appearance）; presence of bleeding loci in fundus, and nephrocalcinosis in kidneys. In light of these symptoms, the patient was diagnosed with pseudoxantoma elasticum. Skin biopsy confirmed the pseudoxantoma elasticum diagnose. PXE is an uncommon, hereditary disease. Early diagnosis of pseudoxantoma elasticum cases, is important for minimalizing systemic complications and informing the other family members through genetic counseling.

Effect of adjuvant reduced glutathione therapy on vasoactive molecules and oxidative stress in patients with cirrhosis-induced upper gastrointestinal hemorrhage

Objective: To study the effect of adjuvant reduced glutathione therapy on vasoactive molecules and oxidative stress in patients with cirrhosis-induced upper gastrointestinal hemorrhage. Methods: Patients diagnosed with cirrhosis-induced upper gastrointestinal hemorrhage in No. 215 Hospital of Shaanxi Nuclear Industry between June 2015 and March 2017 were selected as the research subjects, and random number table was used to divide them into the GSH group who accepted reduced glutathione combined with conventional therapy and the control group who accepted conventional therapy. Serum levels of liver function indexes, vasoactive molecules and oxidative stress reaction molecules in two groups of patients were detected before treatment and 3 d after treatment. Results: 3 d after treatment, serum ALT, AST, γ-GT, TBIL, PRA, AT-Ⅱ, ALD, MDA, ox-LDL, AOPP and 8-OHdG levels of both groups of patients were significantly lower than those before treatment while SOD, GSH-Px and CAT levels were significantly high than those before treatment, and serum ALT, AST, γ-GT, TBIL, PRA, AT-II, ALD, MDA, ox-LDL, AOPP and 8-OHdG levels of GSH group were significantly lower than those of control group while SOD, GSH-Px and CAT levels were significantly higher than those of control group. Conclusion: The adjuvant reduced glutathione therapy for cirrhosis-induced upper gastrointestinal hemorrhage can improve the liver function, regulate the secretion of vasoactive molecules and reduce the oxidative stress response.

Rare presentation of primary (AL) amyloidosis as gastrointestinal hemorrhage without systemic involvement

We are reporting a rare case of a patient with primary(AL) amyloidosis presenting with an acute non-varicealupper gastrointestinal hemorrhage in the absence ofother systemic involvement. The case report involves a58-year-old woman with significant cardiac history andhereditary blood disorder who came in complaining ofabdominal pain and coffee-ground emesis for two days.Computed tomography(CT) scan of the abdomen andpelvis with contrast revealed segmental wall thickeningof the proximal jejunum with hyperdense, heterog-enous luminal content. Similar findings were evident inthe left lower small bowel region, suspicious for smallbowel hematoma and the possibility of intraluminalclots. Esophagogastroduodenoscopy performed postresuscitation showed punctate, erythematous lesionsthroughout the stomach as well as regions of smallbowel mucosa that appeared scalloped, ulcerated, andhemorrhaged on contact. Despite initial treatment for immunostain-positive focal cytomegalovirus gastritis, follow-up esophagogastroduodenoscopy after two months continued to demonstrate friable and irregular duodenal mucosa hinting at a different underlying etiol-ogy. Pathology reports from analyses of biopsy samples highlighted infiltration and expansion of the lamina pro-pria and submucosa. Subsequent staining with congo red/crystal violet and appropriate subtyping established the diagnosis of AL(kappa)-type amyloidosis. The sig-nificance of this case lies in the fact that our patient did not have the typically seen diagnostic systemic involvements-namely of heart and kidneys-usually seen in primary(AL) amyloidosis patients. It was the persis-tent endoscopic findings and biopsy results which gave clues to the physicians regarding the possibility of an abnormal protein-deposition entity.

Endovascular treatment of nonvariceal acute arterial upper gastrointestinal bleeding

Transcatheter arterial embolization as treatment of upper nonvariceal gastrointestinal bleeding is increasingly being used after failed primary endoscopic treatment.The results after embolization have become better and surgery still has a high mortality.Embolization is a safe and effective procedure,but its use is has been limited because of relatively high rates of rebleeding and high mortality,both of which are associated with gastrointestinal bleeding and non-gastrointestinal related mortality causes.Transcatheter arterial embolization is a valuable minimal invasive method in the treatment of early rebleeding and does not involve a high risk of treatment associated complications.A multidisciplinary approach is necessary in the treatment of these patients and should comprise gastroenterologists,interventional radiologists,anaesthesiologists,and surgeons to achieve the best possible results.

Upper gastrointestinal bleeding etiology score for predicting variceal and non-variceal bleeding

AIM： To identify clinical parameters, and develop an Upper Gastrointesinal Bleeding （UGIB） Etiology Score for predicting the types of UGIB and validate the score. METHODS： Patients with UGIB who underwent endoscopy within 72 h were enrolled. Clinical and basic laboratory parameters were prospectively collected. Predictive factors for the types of UGIB were identified by univariate and multivariate analyses and were used to generate the UGIB Etiology Score. The best cutoff of the score was defined from the receiver operating curve and prospectively validated in another set of patients with UGIB. RESULTS： Among 261 patients with UGIB, 47 （18%） had variceal and 214 （82%） had non-variceal bleeding. Univariate analysis identified 27 distinct parameters significantly associated with the types of UGIB. Logistic regression analysis identified only 3 independent factors for predicting variceal bleeding; previous diagnosis of cirrhosis or signs of chronic liver disease （OR 22.4, 95% CI 8.3-60.4, P 〈 0.001）, red vomitus （OR 4.6, 95% CI 1.8-11.9, P = 0.02）, and red nasogastric （NG） aspirate （OR 3.3, 95% CI 1.3-8.3, P = 0.011）. The UGIB Etiology Score was calculated from （3.1× previous diagnosis of cirrhosis or signs of chronic liver disease） ＋ （1.5× red vomitus） ＋ （1.2× red NG aspirate）, when 1 and 0 are used for the presence and absence of each factor, respectively. Using a cutoff ≥ 3.1, the sensitivity, specificity, accuracy, positive predictive value （PPV）, and negative predictive value （NPV） in predicting variceal bleeding were 85%, 81%, 82%, 50%, and 96%, respectively. The score was prospectively validated in cases （46 variceal and 149 another set of 195 UGIB non-variceal bleeding）. The PPV and NPV of a score ≥ 3.1 for variceal bleeding were 79% and 97%, respectively. CONCLUSION： The UGIB Etiology Score, composed of 3 parameters, using a cutoff ≥ 3.1 accurately predicted variceal bleeding and may help to guide the choice of initial therapy for UGIB before endoscopy.

Giant splenic artery aneurysm presenting with massive upper gastrointestinal bleeding:A case report and review of literature

BACKGROUND Splenic artery aneurysm(SAA)and pseudoaneurysm are rare vessel’s lesions.Pseudoaneurysm is often symptomatic and secondary to pancreatitis or trauma.True SAA is the most common aneurysm of visceral vessels.In contrast to pseudoaneurysm,SAA is usually asymptomatic until the rupture,with high mortality rate.The clinical onset of SSA’s rupture is a massive life-threatening bleeding with hemodynamic instability,usually into the free peritoneal space and more rarely into the gastrointestinal tract.CASE SUMMARY We describe the case of a 35-year-old male patient,with negative past medical history,who presented to the emergency department for massive upper gastrointestinal bleeding,severe anemia and hypotension.An esophagogastroduodenoscopy performed in emergency showed a gastric bulging in the greater curvature/posterior wall with a small erosion on its surface,with a visible vessel,but no active bleeding.Endoscopic injection therapy with cyanoacrylate glue was performed.Urgent contrast-enhanced computed tomography was carried out due to the clinical scenario and the unclear endoscopic aspect:The radiological examination showed a giant SAA which was adherent to posterior stomach wall,and some smaller aneurysms of the left gastric and ileocolic artery.Because of the high risk of a two-stage rupture of the giant SAA with dramatic outcome,the patient underwent immediate open surgery with aneurysmectomy,splenectomy and distal pancreatectomy with a good postoperative outcome.CONCLUSION The management of a ruptured giant SAA into the stomach can be successful with surgical approach.

Potential role of new technological innovations in nonvariceal hemorrhage

The present armamentarium of endoscopic hemostatic therapy for non-variceal upper gastrointestinal hemorrhage includes injection,electrocautery and clips.There are newer endoscopic options such as hemostatic sprays,endoscopic suturing and modifications of current options including coagulation forceps and over-the-scope clips.Peptic hemorrhage is the most prevalent type of nonvariceal upper gastrointestinal hemorrhage and traditional endoscopic interventions have demonstrated significant hemostasis success.However,the hemostatic success rate is less for other entities such as Dieulafoy’s lesions and bleeding from malignant lesions.Novel innovations such as endoscopic submucosal dissection and peroral endoscopic myotomy has spawned a need for dependable hemostasis.Gastric antral vascular ectasias are associated with chronic gastrointestinal bleeding and usually treated by standard argon plasma coagulation (APC),but newer modalities such as radiofrequency ablation,banding,cryotherapy and hybrid APC have been utilized as well.We will opine on whether the newer hemostatic modalities have generated success when traditional modalities fail and should any of these modalities be routinely available in the endoscopic toolbox.

急性上消化道出血继发急性肾损伤和病情进展危险因素分析

目的:探讨急性上消化道出血(AUGIB)患者继发急性肾损伤(AKI)和病情进展的危险因素。方法:回顾性分析厦门大学附属东南医院2021年1月至2023年6月收治的233例上消化道出血患者临床资料,根据入院后是否发生AKI分为AKI组(n=67)和非AKI组(n=166),AKI患者根据病情是否进展分为进展组(n=21)和无进展组(n=46)。采用单因素和多因素分析上消化道出血继发急性肾损伤和病情进展的危险因素。结果:233例AUGIB患者中消化道溃疡患者157例、食管胃底静脉曲张42例、急性胃黏膜损伤18例、食管贲门撕裂综合征10例、异物6例。AKI患者67例,发生率为28.76%,其中,21例发生AKI进展,进展率为31.34%。单因素分析发现,冠心病、肝硬化、血小板计数<50×10^(9)/L、血红蛋白计数<60 g/L、血清白蛋白<35 g/L、上消化道出血分级高危及以上AUGIB患者AKI发生率较高(P<0.05)。多因素分析发现,冠心病(OR=2.706,95%CI 1.127~6.494)、血小板计数<50×10^(9)/L(OR=3.570,95%CI 1.249~10.203)、上消化道出血分级高危及以上(OR=3.078,95%CI 1.145~8.227)是AKI发生的独立危险因素。单因素分析发现,67例AUGIB继发AKI患者中,男性、糖尿病、乙型肝炎、肝硬化、既往上消化道出血病史、血小板计数<50×10^(9)/L、血红蛋白计数<60 g/L、血清白蛋白<35 g/L、上消化道出血分级高危及以上患者AKI进展发生率较高(P<0.05)。多因素分析发现,肝硬化(OR=7.975,95%CI 1.400~45.441)、血小板计数<50×10^(9)/L(OR=19.612,95%CI 2.640~145.703)、上消化道出血分级高危及以上(OR=6.814,95%CI 1.183~27.985)是AKI进展的独立危险因素。结论:AUGIB患者要警惕AKI的发生,冠心病、血小板计数<50×10^(9)/L、上消化道出血分级高危及以上是AKI发生的独立危险因素,而肝硬化、血小板计数<50×10^(9)/L、上消化道出血分级高危及以上是AKI进展的独立危险因素。

生长抑素联合奥美拉唑治疗上消化道出血的效果及安全性分析

目的分析上消化道出血应用生长抑素联合奥美拉唑的治疗效果及安全性。方法70例上消化道出血患者,以随机数字表法分为参照组和观察组,各35例。参照组患者以奥美拉唑开展治疗,观察组患者以奥美拉唑+生长抑素开展治疗。对比两组治疗效果、不良反应发生情况、止血时间和住院时间及治疗前后凝血功能[D-二聚体(D-D)、血浆纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)]。结果观察组总有效率97.14%高于参照组的80.00%(P<0.05)。观察组止血时间(12.32±3.36)h、住院时间(7.18±1.74)d短于参照组的(18.23±5.32)h、(10.13±2.23)d(P<0.05)。观察组不良反应发生率2.86%低于参照组的17.14%(P<0.05)。治疗后,观察组D-D(0.53±0.22)mg/L、APTT(26.03±2.12)s、PT(11.13±0.58)s低于参照组的(0.96±0.39)mg/L、(28.42±3.11)s、(13.68±0.68)s,FIB(2.93±0.29)g/L高于参照组的(2.21±0.32)g/L(P<0.05)。结论上消化道出血应用生长抑素联合奥美拉唑治疗效果显著,可有效改善机体的凝血功能,减少出血量,缩短住院时间,并且用药后不良反应较少,安全性较高,值得推广。

特利加压素联合生长抑素治疗肝硬化上消化道出血的疗效及安全性的Meta分析

目的系统评价特利加压素联合生长抑素治疗肝硬化上消化道出血的疗效及安全性。方法检索自建库至2023年7月在PubMed、Cochrane Library、Embase、Web of Science、中国知网(CNKI)、万方数据库、维普数据库(VIP)、中国生物医学文献数据库(SinoMed)等发表的关于特利加压素联合生长抑素治疗肝硬化上消化道出血的随机对照试验(RCTs),试验组采用特利加压素联合生长抑素,对照组单用生长抑素。采用Revman5.3和Stata17软件对全因死亡率、总体有效率、不良事件发生率、止血时间、输血量和住院时间进行Meta分析。结果纳入20项RCTs,共计1502例患者。Meta分析结果显示:与对照组相比,试验组治疗肝硬化上消化道出血可降低全因死亡率(OR=0.34,95%CI:0.19~0.59,P<0.01)和输血量(SMD=-2.29,95%CI:-3.13~-1.46,P<0.01),缩短止血时间(SMD=-1.64,95%CI:-2.03~-1.25,P<0.01)和住院时间(MD=-7.12,95%CI:-7.47~-6.77,P<0.01),提高总体有效率(OR=3.50,95%CI:2.46~4.97,P<0.01);而不良事件的发生率比较差异无统计学意义(OR=1.20,95%CI:0.82~1.75,P=0.34)。结论现有证据表明,与单用生长抑素相比,特利加压素联合生长抑素治疗肝硬化上消化道出血可显著提高总体有效率,降低死亡风险和输血量,缩短止血时间及住院时间,且不增加不良反应。

吲哚布芬与氯吡格雷治疗缺血性心脑血管疾病合并上消化道出血患者的效果与安全性

目的:分析吲哚布芬与氯吡格雷在治疗缺血性心脑血管疾病合并上消化道出血患者中的效果与安全性。方法:选取2021年3月—2023年4月潮州市中心医院收治的60例缺血性心脑血管疾病合并上消化道出血患者,随机将其分为两组,各30例。对照组实施氯吡格雷治疗,观察组实施吲哚布芬治疗,对比两组临床疗效、炎症因子、不良反应情况。结果:干预后,观察组的总有效率为96.67%(29/30),高于对照组的76.67%(23/30),差异有统计学意义(P<0.05)。干预后,观察组hs-CRP、PCT水平明显低于对照组,差异有统计学意义(P<0.05)。观察组不良反应发生率6.67%(2/30),低于对照组的26.67%(8/30),差异有统计学意义(P<0.05)。结论:与氯吡格雷相比,吲哚布芬在治疗缺血性心脑血管疾病合并上消化道出血患者中具有良好的临床效果,能有效改善炎症因子水平,降低不良反应发生率,安全性好。

不同时机内镜治疗老年急性上消化道出血对患者临床结局的影响

目的:探讨不同时间内镜治疗老年急性上消化道出血对患者临床结局的影响。方法:选取晋江市医院2021年5月—2023年5月收治的100例急性上消化道出血患者为对象,根据不同治疗方式进行分组,其中在发病12h内采取内镜治疗为观察组,在发病12~24h采取内镜治疗为参照组,各50例。对比两组围手术期相关指标、生化指标及临床治疗结局。结果:观察组输血量少于参照组,手术时间、呕血或黑便停止时间、术后进食时间及住院时间均短于参照组(P<0.05)。治疗后,观察组血小板、血红蛋白及血清白蛋白指标均高于参照组(P<0.05)。两组再出血、转入重症监护病房、术后30 d复发及死亡发生率比较,差异均无统计学意义(P>0.05)。结论:与发病12~24 h采取内镜治疗相比,对老年急性上消化道出血在发病12h内进行内镜治疗可取得更为理想的干预及止血效果,积极缩短相关治疗时间。

内镜下钛夹止血联合泮托拉唑、生长抑素治疗上消化道大出血的效果及对凝血指标的影响

目的探究内镜下钛夹止血联合泮托拉唑、生长抑素治疗上消化道大出血的效果及对凝血指标的影响。方法择取2021年1月至2022年12月收治的120例上消化道大出血患者为研究对象,随机将其分为对照组和观察组,每组60例。对照组采用泮托拉唑、生长抑素治疗,观察组在对照组基础上加内镜下钛夹止血治疗。比较两组的治疗效果。结果观察组的治疗总有效率为95.00%,高于对照组的80.00%(P<0.05)。治疗后,观察组的凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)短于对照组,纤维蛋白原(FIB)水平及血小板计数(PLT)高于对照组(P<0.05)。治疗后,观察组的胃泌素(GAS)、胃动素(MTL)水平低于对照组,生长抑素(SS)水平高于对照组(P<0.05)。结论内镜下钛夹止血联合泮托拉唑、生长抑素治疗上消化道大出血的效果明显,不仅能够改善凝血指标,还能调节胃肠激素水平,减轻出血症状。

PLT、IGFBP-3、ALB联合诊断对肝硬化上消化道出血的预测价值

目的探究血清血小板计数(PLT)、胰岛素样生长因子结合蛋白-3(IGFBP-3)、白蛋白(ALB)水平对肝硬化上消化道出血(UGH)的预测价值。方法选取136例肝硬化患者,根据治疗后有无UGH分为出血组(43例)、未出血组(93例),比较两组不同肝硬化分级患者血清PLT、IGFBP-3、ALB水平与肝纤维指标,并分析相关性及预测价值。结果出血组PLT、ALB、Ⅳ型胶原水平低于未出血组,血清IGFBP-3水平及层粘连蛋白、透明质酸高于未出血组,差异有统计学意义(P<0.05)。比较出血组不同Child-Pugh分级(A级、B级、C级)的血清PLT、ALB、Ⅳ型胶原水平:A级>B级>C级,血清IGFBP-3水平、层粘连蛋白、透明质酸:C级>B级>A级(P<0.05)。层粘连蛋白、透明质酸及Child-Pugh分级与血清PLT、ALB呈负相关,与血清IGFBP-3呈正相关;Ⅳ型胶原水平与血清PLT、ALB呈正相关,与血清IGFBP-3呈负相关(P<0.05)。血清PLT、IGFBP-3、ALB水平联合预测的AUC大于各指标单独预测。结论血清PLT、IGFBP-3、ALB水平联合预测可为临床评估肝硬化患者并发UGH提供可靠依据。

ABC评分、AIMS65评分、格拉斯哥-布拉奇福德评分对上消化道出血病人死亡的预测价值比较

目的 比较ABC(年龄、血液学、合并症)评分、AIMS65评分、格拉斯哥-布拉奇福德评分(GBS)预测急性上消化道出血(AUGIB)病人死亡方面的表现。方法 回顾性收集2018年12月至2022年1月于徐州医科大学附属医院确诊为AUGIB的330例病人资料,根据病人住院期间的生存情况,分为存活组(304例)和死亡组(26例)。收集病人的一般资料和实验室检查结果,进行ABC、AIMS65和GBS,评估3种评分对AUGIB病人住院死亡的预测能力。结果 两组病人的年龄、血清白蛋白(ALB)、国际标准化比值(INR)、ABC评分、AIMS65评分、GBS及有无吸烟、恶性肿瘤、心衰、黑便、晕厥等的比较差异有统计学意义(P<0.05)。与存活组相比,死亡组病人的ABC评分[9.50(7.50,12.00)比3.00(2.00,5.00)]、AIMS65评分、GBS、INR[1.53(1.16,1.90)比1.03(0.96,1.16)]显著升高(P<0.05)。logistic回归分析显示ALB、INR、ABC评分是AUGIB病人住院死亡的独立危险因素。ROC曲线显示三种评分对AUGIB病人住院死亡均有一定预测价值,ABC评分预测住院死亡的价值较高,AUC 95%CI为0.90(0.87,0.94)、P<0.001,灵敏度为84.6%,特异度为90.5%;AIMS65评分和GBS具有中等预测价值,AUC 95%CI分别为0.84(0.80,0.88)、P<0.001,0.82(0.78,0.86)、P<0.001,灵敏度分别为76.9%、69.2%,特异度分别为81.6%、87.8%。结论 ABC评分对AUGIB病人住院死亡的预测价值较好,AIMS65评分和GBS的预测价值中等。

Blatchford分级管理在急性上消化道出血患者中的应用

目的探究Blatchford分级管理在急性上消化道出血患者中的应用效果。方法选择2020年1月至2023年1月江苏省如皋市中医院诊治的92例急性上消化道出血患者,依据随机数字表法将其分为对照组和观察组,每组46例。对照组采取常规护理,观察组应用Blatchford分级管理。比较两组干预前后我效能感量表(GSES)评分、粪便隐血试验转阴时间、恢复肠鸣音时间、止血时间及住院时间;观察并发症的发生情况。结果干预后,两组GSES评分均较干预前升高,且观察组高于对照组,差异有统计学意义(P<0.05)。观察组粪便隐血试验转阴时间、恢复肠鸣音时间、止血时间及住院时间短于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论Blatchford分级管理可缩短急性上消化道出血患者的临床恢复时间,降低并发症的发生率,预后良好。