英国急性上部胃肠道出血:2022年审计更新
Gaurav B Nigam1, Kathryn Oakland2, Sarah Hearnshaw3
1Translational Gastroenterology and Liver Unit, Oxford University Hospitals NHS Trust, Oxford, UK gaurav.nigam@ouh.nhs.uk acdouds@gmail.com.
Gut
|November 19, 2025
概括
对于急性上部胃肠道出血 (AUGIB) 的结果有所改善,尽管患者病情更糟,并且没有遵守指南. 限制性输血实践至关重要,因为在稳定的患者中,高于80g/L的自由输血增加了死亡率.
科学领域:
- 胃肠病学 胃肠病学
- 内部医学 内部医学
- 临床审计 临床审计
背景情况:
- 急性上部胃肠道出血 (AUGIB) 是一个重要的医疗紧急情况.
- 管理策略,包括医疗/内镜治疗和输血协议,正在不断发展.
- 最近的英国审计提供了有关AUGIB当前人口统计和治疗方法的关键数据.
研究的目的:
- 介绍2022年英国对AUGIB的审计的主要发现.
- 将2022年的数据与之前的2007年审计调查结果进行比较.
- 识别趋势并评估AUGIB管理和结果随时间变化的变化.
主要方法:
- 一个前性的多中心审计,涉及147家英国医院.
- 从2022年5月至7月期间接受AUGIB的成年患者 (≥16岁) 收集的数据.
- 追踪患者结果直到出院,死亡或28天,重新入院被计算为新发作.
主要成果:
- 与2007年相比,2022年队列 (5141名患者) 的共患病率 (67%),肝硬化 (15%) 和抗凝剂使用率 (31%) 较高.
- 胃病 (32%) 和没有异常 (33%) 是常见的原因;42%缺乏前内镜风险分层.
- 尽管增加了危险因素,但结果有所改善:再出血减少到9.7%,住院死亡率降至8.8%,住院时间中位数降至5天.
- 在稳定的患者中,自由输血 (Hb>70 g/L) 与死亡率增加有关 (aOR为1.60在80 g/L).
结论:
- 尽管AUGIB患者的风险较高,并且遵守指南的程度低于最佳水平,但AUGIB的结果有所改善.
- 限制性输血策略至关重要,特别是避免在稳定的患者中 liberal 输血超过 80 g/L.
- 建议采取重点关注风险分层,内镜培训和多学科护理的质量改进举措,以进一步改善结果.
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