この患者さんは重度の上部胃腸出血をしていますか?
F Douglas Srygley1, Charles J Gerardo, Tony Tran
1Department of Medicine, Duke University Medical Center, PO Box 3913, Durham, NC 27710, USA. srygl001@mc.duke.edu
JAMA
|March 15, 2012
まとめ
上部胃腸出血 (UGIB) と下部胃腸出血 (LGIB) を区別することは,緊急医療の医師にとって極めて重要です. メレーナ,特定のNG洗浄結果,およびBUN:クレアチニン比率は,UGIBを特定するのに役立ちますが,ブラッチフォードスコアはリスクの階層化に役立ちます.
科学分野:
- 胃腸内科 胃腸内科
- 緊急医療 緊急医療
- クリニカル診断士
背景:
- 急性上部胃腸出血 (UGIB) と急性下部胃腸出血 (LGIB) を正確に区別することは,緊急医療の医師が適切な診断および治療戦略を導くために不可欠です.
- UGIBの重度の決定は,緊急の介入を必要とする患者を特定するために重要です.
研究 の 目的:
- UGIBとLGIBを区別する歴史的特徴,症状,徴候,ベッドサイドの操作,検査結果を特定する.
- 緊急の介入を必要とする可能性が最も低いUGIB患者のリスク分層化.
主な方法:
- MEDLINEの体系的な文献検索と参考リスト (1966-2011).
- 緊急治療室で評価された,またはGIBで入院した成人の患者に関する高品質の研究を含める.
- データ抽象には,ランダム効果メタ解析による流行度,感度,特異性,および確率比 (LRs) が含まれていた.
主要な成果:
- メレーナ,メレーニック便,血まみれの鼻胃洗浄,BUN:クレアチニン比>30はUGIBの指標です.
- 便の血栓はUGIBの可能性を低下させます.
- タチカルディア,ヘモグロビン<8g/dL,または血性鼻胃洗浄は,緊急の介入を必要とする重度のUGIBを予測します.
- 0のブラッチフォードスコアは,緊急の介入を必要としないUGIBを強く示唆しています.
結論:
- メレーナ,鼻胃洗浄の発見,BUN:クレアチニン比率などの臨床的要因は,UGIBを特定するのに役立ちます.
- ブラッチフォードスコアは,リスクの階層化のための貴重なツールであり,直ちに介入を必要としないUGIBの患者を効率的に特定します.
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