上部胃腸出血の治療の必要性を予測するためのリスクスコア
O Blatchford1, W R Murray, M Blatchford
1Department of Public Health, University of Glasgow, UK. o.blatchford@bigfoot.com
Lancet (London, England)
|November 10, 2000
まとめ
新しいリスクスコアは,急性上胃腸出血の治療を必要とする患者を正確に特定します. このツールは,臨床医が出血を管理し,患者のリスクを効果的に層分化するのに役立ちます.
科学分野:
- 胃腸内科 胃腸内科
- クリニカル・メディシン 臨床医学
- 医療情報工学 医療情報工学
背景:
- 急性上部胃腸出血 (UGIB) の既存のリスク分層システムは,死亡または再出血のリスクが高くまたは低い患者を分類します.
- UGIB患者の治療決定を導くために,検証されたリスクスコアが必要である.
研究 の 目的:
- 医療介入を必要とするUGIB患者の特定のためのリスクスコアを開発し,将来的に検証する.
- 患者の初期評価のための簡素化された高速スクリーニングツールを作成する.
主な方法:
- 1748人のUGIB患者からのデータに対するロジスティック回帰を用いてリスクスコアを導き,輸血,介入,再出血,または死亡の必要性を予測しました.
- このスコアと簡素化されたスクリーニングツールは,受容器操作特性 (ROC) 曲線と chi2 適合性テストを用いて,197人のUGIB患者で前向きに検証されました.
主要な成果:
- リスクスコアには,入院ヘモグロビン,血尿素,脈拍,静脈血圧,昏睡,メレーナ,肝疾患,心不全が含まれていました.
- 開発されたスコアは,治療の必要性を予測するための優れた差別 (ROC曲線面積0.92) と良好な校正 (p=0.84) を示した.
結論:
- 検証されたリスクスコアは,低リスクまたは高リスクのUGIB患者の治療を必要とする患者を効果的に特定します.
- このスコアは,UGIBの臨床管理に役立ちますが,外部検証は推奨されます.
関連する概念動画
01:28Esophageal Varices-II: Clinical Features and Management
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
01:23Gastritis III: Clinical Manifestations and Management
The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:26Peptic Ulcer Disease IV: Management
Medical treatment strategies for peptic ulcers encompass various methods. The primary goal of treatment is to diminish gastric acidity and strengthen mucosal defense mechanisms.
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
The therapeutic approach involves ensuring adequate rest, implementing drug therapy, promoting smoking cessation, making dietary modifications, and emphasizing long-term follow-up care.
Pharmacological management
The prevailing therapy for peptic ulcers involves a combination of managing the patient's current medication...
01:27Peptic Ulcer
Peptic ulcers are erosive lesions of the gastric or duodenal lining, most commonly caused by Helicobacter pylori infection. This Gram-negative, helical bacterium has adapted to survive the stomach’s acidic environment by producing urease, which converts urea into ammonia and carbon dioxide. The ammonia neutralizes gastric acid in the bacterium’s immediate environment, allowing colonization of the gastric mucosa. H. pylori attaches to mucus-secreting epithelial cells, penetrates the mucus...