这个病人有严重的上部胃肠道出血吗?
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
概括
区分上部胃肠道出血 (UGIB) 和下部胃肠道出血 (LGIB) 对紧急医生至关重要. 梅莱纳,特定的NG洗结果和BUN:肌素比率有助于识别UGIB,而布拉奇福德得分有助于风险分层.
科学领域:
- 胃肠病学 胃肠病学
- 紧急医疗 紧急医疗
- 临床诊断 临床诊断 临床诊断
背景情况:
- 精确区分急性上部胃肠道出血 (UGIB) 和急性下部胃肠道出血 (LGIB) 对于紧急医生指导适当的诊断和治疗策略至关重要.
- 确定UGIB的严重程度对于识别需要紧急干预的患者至关重要.
研究的目的:
- 识别历史特征,症状,迹象,床边操纵和实验室结果,使UGIB与LGIB有所区别.
- 为了对UGIB患者进行风险分层,这些患者不太可能需要紧急干预.
主要方法:
- 对MEDLINE和参考清单 (1966-2011) 的系统文献搜索.
- 包括在急诊室评估的成年患者或因GIB而入院的高质量研究.
- 数据抽象包括流行率,敏感性,特异性和概率比率 (LRs),随机效应元分析.
主要成果:
- 黑色,黑色便,血淋淋的鼻胃洗,以及BUN:肌素比>30都是UGIB的指标.
- 便中的血栓降低了UGIB的可能性.
- 慢心,血红蛋白<8g/dL,或血性鼻胃洗预测严重的UGIB需要紧急干预.
- 布拉奇福德分数为0强烈表明UGIB不需要紧急干预.
结论:
- 临床因素,如梅琳娜,鼻胃洗的发现,以及BUN:肌素比率,有助于识别UGIB.
- 布拉奇福德评分是风险分层的一个有价值的工具,可以有效地识别不需要立即干预的UGIB患者.
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