A comparative study of Glasgow-Blatchford score early combined with multi-disciplinary team and traditional consultation mode in the treatment of upper gastrointestinal bleeding
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摘要: 目的 探讨Glasgow-Blatchford评分(Glasgow-Blatchford score，GBS)早期联合多学科协作诊疗模式(multi-disciplinary team，MDT)对比传统会诊模式救治急性上消化道出血的疗效。方法 选取2021年2月-2021年12月山东省青岛市第三人民医院急诊科收治的GBS≥6分的急性上消化道出血患者160例，以随机数字表法分为MDT组80例及对照组80例。MDT组患者立即启动MDT治疗方案，对照组采用传统会诊模式治疗上消化道出血。对2组患者的急诊内镜完成率、止血成功率、住院时间进行对比分析。随访1年，比较1年内再出血率及全因死亡率，并将年龄、性别、红细胞输注量、MDT管理、入院时GBS、肝肾功能、凝血指标、白蛋白、血常规相关指标、血糖、动脉血乳酸水平纳入回归分析，评价各变量与1年内全因死亡率的相关性。结果 MDT组的急诊内镜完成率、内镜下止血成功率均高于对照组，内镜完成时间、住院时间较对照组缩短，随访1年内再出血率及全因死亡率低于对照组，差异有统计学意义(P < 0.05)。单因素分析显示2组间红细胞输注量、MDT管理、血红蛋白水平、血小板计数、乳酸水平差异有统计学意义，将上述因素作为变量纳入多因素logistic回归分析，结果显示MDT管理是1年内全因死亡率的保护性因素，红细胞输注量是全因死亡率的高危因素。结论 基于GBS早期启动MDT模式救治急性上消化道出血的疗效优于传统会诊模式，可最大程度地保障患者的生命安全。
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关键词:
- 多学科诊疗模式 /
- Glasgow-Blatchford评分 /
- 急性上消化道出血
Abstract: Objective To explore the efficacy of Blatchford score combined with multi-disciplinary team(MDT) in the early stage of acute upper gastrointestinal bleeding compared with the traditional consultation mode.Methods From February 2021 to December 2021, 160 cases of acute upper gastrointestinal bleeding with Glasgow-Blatchford(GBS) bleeding score ≥ 6 were selected from the emergency department of Qingdao Third People's Hospital, Shandong Province. They were divided into MDT group(80 cases) and control group(80 cases) by random number table. The MDT group patients immediately started the MDT treatment program, while the control group treated upper gastrointestinal bleeding with traditional consultation mode. The completion rate of emergency endoscopy, the success rate of hemostasis and the length of hospitalization of the two groups were compared and analyzed. oneyear, compare the rate of rebleeding and all-cause mortality within one year, and include age, sex, red blood cell infusion volume, MDT management, GBS score at admission, ALT, AST, PT, APTT, albumin, BUN, HGB, PLT, WBC, blood glucose, arterial blood lactic acid level into the regression analysis to evaluate the correlation between each variable and all-cause mortality within one year.Results The completion rate of emergency endoscopy and the success rate of endoscopic hemostasis in the MDT group were higher than those in the control group, the completion time of endoscopy and the hospitalization time were shorter than those in the control group, and the rebleeding rate and all-cause mortality rate within one year of follow-up were lower than those in the control group, the difference was statistically significant(P < 0.05). Univariate analysis showed that red blood cell infusion volume, MDT management, HGB level, PLT level, and lactic acid level were selected as variables, and then included in multivariate logistic regression analysis. The results showed that MDT management was a protective factor for all-cause mortality within one year, and red blood cell infusion volume was a high-risk factor for all-cause mortality.Conclusion The MDT mode based on GBS is better than the traditional consultation mode in the treatment of acute upper gastrointestinal bleeding, which can guarantee the life safety of patients to the greatest extent. -
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表 1 2组患者临床资料比较
例(%) 指标 MDT组(n=80) 对照组(n=80) P 年龄/岁 62.0(55.0，70) 57.0(52.0，66.0) 0.89 男性 55(68.8) 50(62.5) 0.40 高血压 45(56.3) 38(47.5) 0.55 糖尿病 29(36.3) 23(28.8) 0.41 冠心病 21(26.3) 18(22.5) 0.69 发病时间/h 6.6±4.2 6.4±4.1 0.44 GBS评分/分 10.4±2.6 10.9±2.9 0.63 出血病因 0.92 消化性溃疡 40(50.0) 42(52.5) 胃底食管静脉曲张 21(26.3) 21(26.3) 其他 19(23.8) 17(21.3) 红细胞/(×1012/L) 3.24±1.14 2.73±1.06 0.34 血红蛋白/(g/L) 83.5±26.6 81.8±25.2 0.25 血小板/(×109/L) 114.2±76.5 105.6±83.3 0.12 APTT/s 15.8±26.6 81.8±25.2 0.25 PT/s 15.6±3.2 16.3±3.6 0.12 
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表 2 2组观察指标比较
例(%) 项目 急诊内镜率 内镜止血成功率 内镜完成时间/h 住院时间/d 院内再出血率(1年内) 全因死亡率(1年内) MDT组(n=80) 80(100.0) 76(95.0) 10(6，18) 7(5，10) 3(3.8) 16(20.0) 对照组(n=80) 70(87.5) 64(80.0) 18(10，22) 9(6，12) 10(12.5) 28(35.0) P < 0.05 < 0.05 < 0.05 < 0.05 0.04 0.03
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表 3 全因死亡率的危险因素分析
变量 单因素分析 多因素分析 OR (95%CI) P OR (95%CI) P 年龄 1.01(0.99~1.02) 0.08 性别 1.02(0.62~1.70) 0.91 1.51(0.87~2.62) 0.14 红细胞输注量 1.45(1.03~2.05) 0.03 1.67(1.20~2.67) 0.02 GBS评分 1.23(0.61~2.49) 0.57 MDT 0.74(0.61~0.87) 0.02 0.79(0.63~0.84) 0.03 ALT 1.01(0.99~1.02) 0.09 AST 0.99(0.99~1.00) 0.43 PT 0.99(0.97~1.01) 0.25 APTT 1.02(0.98~1.07) 0.32 白蛋白 1.00(0.99~1.00) 0.91 BUN 0.85(0.59~1.22) 0.38 HGB 0.92(0.88~0.96) 0.01 0.93(0.85~1.02) 0.12 PLT 0.98(0.97~0.99) 0.04 0.99(0.99~1.01) 0.56 WBC 1.02(0.99~1.04) 0.24 血糖 1.03(0.96~1.09) 0.38 乳酸 1.16(1.00~1.36) 0.04 1.01(0.84~1.22) 0.88
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