急性上消化道出血死亡相关危险因素分析

doi:10.3969/j.issn.1002-1949.2018.02.013

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摘要目的分析急性上消化道出血的死亡相关因素，并预测评估其病死率。方法回顾性收集2013-01~2017-07在北京积水潭医院诊治的急性上消化道出血患者，采集患者入院时的临床特征、既往史、诊治情况及转归，根据有无肝病，将患者分为肝病组和非肝病组，再以院内/30 d内死亡作为结局，将肝病组分为死亡组和存活组，采用SPSS 18.0软件进行数据分析，并绘制生存曲线和ROC曲线。分别计算AIMS65、Glasgow-Blachford(GBS)、Pre-Rockall和ALBI等四种评分的数值，以院内/30 d内死亡为终点，绘制ROC曲线，比较曲线下面积（AUC）以评价四种方法的优劣。结果共选入240例患者，非肝病组179例（74.58%），死亡5例（2.79%），肝病组61例（25.42%），死亡16例（26.20%），两组病死率比较差异有统计学意义（P＜0.05）。肝病组在发病2～5 d内存活率较非肝病组明显下降。肝病组中，死亡组的年龄、呕血、意识障碍、晕厥、总胆红素升高等与生存组比较差异均有统计学意义（P＜0.05）。ALBI评分可有效地预测总体患者和肝病组患者的病死率，AUC均>0.8，与AMIS65、Pre-Rockall评分相当。但在非肝病组中，AUC值为0.742，低于其他三种评分。结论急性上消化道出血的死亡危险因素有肝病病史、年龄增大、呕血、合并意识障碍、血总胆红素升高等。ALBI评分、AMIS65评分、Pre-Rockall评分均可以有效地预测病死率，ALBI评分简单客观，适合应用于急诊科快速病情评估。

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	涂家红
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收稿日期: 2017-10-24

通讯作者: 赵斌（1960-），男，主任医师，教授，急诊科主任，E-mail：zhaobin60@aliyun.com。

作者简介: 涂家红（1977-），女，硕士研究生，主治医师。

引用本文:

涂家红，张明清，赵斌. 急性上消化道出血死亡相关危险因素分析[J]. 中国急救医学, 2018, 38(2): 152-158.
Tu Jia-hong, Zhang Ming-qing, Zhao Bin. Risk factors for death in patients with acute upper gastrointestinal bleeding. Chinese Journal of Critical Care Medicine, 2018, 38(2): 152-158.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.02.013 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I2/152

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