Construction effect evaluation of fast-track emergency treatment mode for dangerous upper gastrointestinal hemorrhage
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摘要: 目的 通过与传统救治模式比较,评价危险性上消化道出血患者在危险性上消化道出血急诊救治快速通道模式下的救治效果。方法 回顾性分析2018年7月—2022年9月我院急诊收治的危险性上消化道出血患者的临床资料,将2018年7月—2019年12月采用传统救治模式救治的77例患者纳入对照组;将2021年4月—2022年9月采用快速通道模式救治的94例患者纳入研究组。比较2组患者抢救室滞留时间、门镜时间、24 h内胃镜完成率、输血量、1周内止血有效率、住院费用、住院时间、住院期间病死率等。结果 研究组的抢救室滞留时间(min)、门镜时间(h)、总输血量(单位)、住院时间(d)明显低于对照组,差异有统计学意义(P < 0.05);研究组24 h内胃镜完成率、1周内止血有效率明显高于对照组,差异有统计学意义(P < 0.05);2组住院费用(元)、介入手术率、外科手术率及病死率差异无统计学意义(P>0.05)。结论 与传统救治模式相比,危险性上消化道出血急诊救治快速通道模式可缩短抢救室滞留时间、门镜时间和住院时间,减少输血量,提高24 h内胃镜完成率,提高1周内止血有效率。Abstract: Objective To evaluate the effect of fast-track emergency treatment mode for patients with dangerous acute upper gastrointestinal hemorrhage by comparing with the traditional treatment mode.Methods The clinical data of patients with dangerous acute upper gastrointestinal hemorrhage admitted to our hospital from July 2018 to September 2022 were analyzed retrospectively. From July 2018 to December 2019, 77 patients treated with traditional treatment mode were included in the control group. From April 2021 to September 2022, 94 patients who were treated with fast-track mode were included in the study group. The retention time in the emergency room, door-gastroscopy time, gastroscopy completion rate within 24 hours, volume of blood transfusion, hemostasis efficiency within 7 days, hospitalization expenses, length of stay and mortality during hospitalization were compared between the two groups.Results The retention time in the emergency room(minutes), the door-gastroscopy time(hours), the total blood transfusion(unit), and the hospital stay(days) in the study group were significantly lower than those in the control group(P < 0.05); The completion rate of gastroscope within 24 hours and the effective rate of hemostasis within 1 week in the study group were significantly higher than those in the control group(P < 0.05); There was no significant difference in hospital costs(Yuan), interventional operation rate, surgical operation rate and mortality between the two groups(P>0.05).Conclusion Compared with the traditional treatment mode, the fast-track mode of emergency treatment for dangerous acute upper gastrointestinal hemorrhage can shorten retention time in emergency room, door-gastroscopy time and the time of hospitalization, reduce blood transfusion volume, improve the completion rate of gastroscopy within 24 hours, and improve the efficiency of hemostasis within 7 days.
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表 1 2组患者的基线资料比较
例(%),M(P25,P75) 基线资料 对照组(n=77) 研究组(n=94) z/χ2 P 年龄/岁 66.00(51.00,75.50) 62.00(55.75,74.00) -0.31 0.76 性别 0.06 0.81 男 44(57.1) 52(55.3) 女 33(42.9) 42(44.7) 有无合并症 0.12 0.73 无 29(37.7) 33(35.1) 有 48(62.3) 61(64.9) GBS评分/分 5.0(2.5,12.0) 8.5(4.0,13.0) -1.33 0.18 胃镜诊断 0.44 0.80 不明确 6(7.8) 5(5.3) 静脉曲张出血 26(33.8) 32(34) 非静脉曲张出血 45(58.4) 57(66.6) 表 2 2组治疗情况及预后比较
例(%),M(P25,P75) 指标 对照组(n=53) 研究组(n=61) z/χ2 差值及95%CI P 抢救室滞留时间/min 48.00(40.00,60.50) 33.00(30.00,38.25) -9.480 -16(-20~-12) 0.001 门镜时间/h 22(18,37) 10(6,20) -7.070 -13(-15~-10) 0.001 24 h胃镜完成 43(55.8) 85(90.4) 26.890 34.6%(21.5%~46.5%) 0.001 总输血量/U 5(3,7) 3(2,4) -4.310 -2(-2~-1) 0.001 住院时间/d 8.0(6.0,12.0) 6.0(5.0,9.3) -3.470 -2(-3~-1) 0.001 住院费用/元 32 164(24 639,43 328) 31 398(24 660,42 112) -2.000 -313(-4682~3610) 0.835 介入治疗 5(6.5) 7(7.4) 0.059 0.95%(-6.69%~8.6%) 0.808 外科手术治疗 3(3.9) 2(2.1) 0.466 -1.7%(-6.9%~3.4%) 0.495 1周内止血有效 58(75.3) 84(89.4) 5.920 14%(2.5%~25.5%) 0.015 死亡 5(6.5) 3(3.2) 1.035 -3.3%(-9.8%~3.2%) 0.309 -
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