本文選題：AIMS65評(píng)分系統(tǒng) + Glasgow-Blatchford評(píng)分系統(tǒng)��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景急性上消化道出血(acute upper gastrointestinal bleeding AUGIB)是臨床常見(jiàn)的急危重癥,起病急、病情發(fā)展快,根據(jù)病情的嚴(yán)重程度可以導(dǎo)致不同的后果,輕者僅表現(xiàn)為頭暈、乏力、暈厥等不典型癥狀,病情危重者可導(dǎo)致周圍循環(huán)衰竭、休克,甚至危及生命。如何根據(jù)患者的臨床表現(xiàn)、實(shí)驗(yàn)室檢查結(jié)果迅速、準(zhǔn)確地制定合理的治療方案、預(yù)測(cè)預(yù)后是臨床醫(yī)生關(guān)注的焦點(diǎn)。目的探討AIMS65和Glasgow-Blatchford評(píng)分系統(tǒng)(GBS)對(duì)AUGIB患者臨床干預(yù)(輸血以及轉(zhuǎn)ICU治療)及預(yù)后(再出血和死亡)的預(yù)測(cè)價(jià)值。方法記錄鄭州大學(xué)第一附屬醫(yī)院2015年1月-2016年7月收治的339例符合研究標(biāo)準(zhǔn)及資料完整的AUGIB臨床資料。計(jì)算所有入院患者AIMS65和GBS積分,比較不同分值患者的臨床干預(yù)及預(yù)后情況。計(jì)算兩種評(píng)分系統(tǒng)的受試者工作曲線下面積(area under the receiver operating characteristic curve,AUC),評(píng)估其對(duì)AUGIB患者臨床干預(yù)及不同預(yù)后的預(yù)測(cè)價(jià)值。根據(jù)約登指數(shù),比較兩種危險(xiǎn)評(píng)估系統(tǒng)對(duì)不同預(yù)后及臨床干預(yù)的最佳臨界值。結(jié)果(1)AIMS65隨著分?jǐn)?shù)的增高,輸血率、轉(zhuǎn)ICU率、再出血率、病死率風(fēng)險(xiǎn)增高。(2)GBS隨著分?jǐn)?shù)的增高,輸血率、轉(zhuǎn)ICU率、再出血率、病死率風(fēng)險(xiǎn)增高。(3)GBS對(duì)輸血率的預(yù)測(cè)價(jià)值高于AIMS65評(píng)分系統(tǒng)(AUC 0.800 vs 0.727P0.05);GBS對(duì)再出血率的預(yù)測(cè)價(jià)值高于AIMS65評(píng)分系統(tǒng)(AUC 0.713 vs 0.698P0.05);AIMS65評(píng)分系統(tǒng)對(duì)病死率的預(yù)測(cè)價(jià)值高于GBS(AUC 0.859 vs 0.813P0.05);GBS對(duì)轉(zhuǎn)ICU率的預(yù)測(cè)價(jià)值與AIMS65評(píng)分系統(tǒng)相似(AUC 0.832 vs0.833 P0.05)。(4)AIMS65評(píng)分系統(tǒng)對(duì)輸血、轉(zhuǎn)ICU、再出血、死亡預(yù)測(cè)的最佳臨界值是2分。GBS對(duì)輸血的最佳臨界值為11分,死亡和轉(zhuǎn)ICU的最佳臨界值為14分,再出血預(yù)測(cè)的最佳臨界值是13分。結(jié)論1.AIMS65評(píng)分系統(tǒng)在預(yù)測(cè)病死率方面優(yōu)于GBS,但在預(yù)測(cè)輸血率以及再出血率方面GBS優(yōu)于AIMS65評(píng)分系統(tǒng),在預(yù)測(cè)轉(zhuǎn)ICU率方面,兩者的準(zhǔn)確性相似。2.AIMS65對(duì)于臨床干預(yù)及不同預(yù)后的最佳臨界值為2分。
[Abstract]:Background Acute upper gastrointestinal bleeding AUGIBB (acute upper gastrointestinal bleeding AUGIBB) is a common clinical acute and critical disease, with rapid onset and rapid development. According to the severity of the disease, it can lead to different consequences. The mild patients only show atypical symptoms, such as dizziness, fatigue, syncope and so on.Critical patients can cause peripheral circulatory failure, shock, and even life-threatening.It is the focus of clinicians how to make reasonable treatment plan and predict prognosis according to the clinical manifestation and the results of laboratory examination.Objective to evaluate the predictive value of AIMS65 and Glasgow-Blatchford scoring system in clinical intervention (blood transfusion and conversion to ICU treatment) and prognosis (rebleeding and death) in AUGIB patients.Methods the clinical data of 339 AUGIB patients admitted to the first affiliated Hospital of Zhengzhou University from January 2015 to July 2016 were recorded.The AIMS65 and GBS scores of all patients were calculated, and the clinical intervention and prognosis of patients with different scores were compared.The area under the operating curve of under the receiver operating characteristic was calculated to evaluate its predictive value for clinical intervention and different prognosis in patients with AUGIB.According to the Jorden index, the optimal critical values of two risk assessment systems for different prognosis and clinical intervention were compared.Results with the increase of the score, the blood transfusion rate, the conversion rate of ICU, the rate of rebleeding and the risk of death were increased. With the increase of the fraction, the blood transfusion rate, the rate of conversion to ICU, the rate of rebleeding, and the rate of rebleeding were increased with the increase of the score of AIMS65.The predictive value of GBS to blood transfusion rate is higher than that of AIMS65 scoring system (AUC 0.800 vs 0.727 P0.05GBS) in predicting the rate of re-bleeding. It is higher than that of AIMS65 scoring system (AUC 0.713 vs 0.698P0.05% AIMS65) in predicting mortality rate. It is higher than that of GBS(AUC 0.859 vs 0.813P0.05GBS in predicting mortality.The predictive value of ICU rate was similar to that of AIMS65 scoring system.The best critical value for ICU, rebleeding, and death prediction was 11 for blood transfusion, 14 for death and ICU, and 13 for rebleeding.Conclusion 1.AIMS65 scoring system is superior to GBS in predicting mortality rate, but GBS is superior to AIMS65 scoring system in predicting blood transfusion rate and rebleeding rate, and in predicting ICU rate.The accuracy of AIMS65 was similar. 2. The best critical value of AIMS65 for clinical intervention and different prognosis was 2 points.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R573.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 陳劍;唐帥;唐小華;;AIMS65評(píng)分系統(tǒng)在急性上消化道出血患者中的應(yīng)用研究[J];中國(guó)醫(yī)學(xué)創(chuàng)新;2016年01期

2 周光文;楊連粵;;肝硬化門靜脈高壓癥食管、胃底靜脈曲張破裂出血診治專家共識(shí)(2015)[J];中國(guó)實(shí)用外科雜志;2015年10期

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本文編號(hào)：1773599