无呕血患者诊断性鼻胃管抽吸的实用性和有效性

Usefulness and validity of diagnostic nasogastric aspiration in patients without hematemesis.

作者信息

Witting Michael D, Magder Laurence, Heins Alan E, Mattu Amal, Granja Carlos A, Baumgarten Mona

机构信息

Division of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.

出版信息

Ann Emerg Med. 2004 Apr;43(4):525-32. doi: 10.1016/j.annemergmed.2003.09.002.

DOI:10.1016/j.annemergmed.2003.09.002

PMID:15039700

Abstract

STUDY OBJECTIVE

We estimate the test characteristics of nasogastric aspiration to diagnose upper gastrointestinal tract hemorrhage in patients without hematemesis.

METHODS

In this retrospective cohort study, medical records from patients admitted to 2 urban hospitals between 1997 and 2002 for gastrointestinal tract bleeding without hematemesis were reviewed. Positive nasogastric aspiration results were classified by the severity of hemorrhage, and negative results were classified by the presence or absence of bile. The reference standard for nasogastric aspiration was the source of bleeding-upper versus non--upper gastrointestinal tract--from the hospital discharge summary. Confidence intervals (CIs) for proportions and likelihood ratios (LRs) were calculated.

RESULTS

Of 333 eligible patients, 235 were offered nasogastric aspiration, and 220 accepted the test. Results of 220 attempts were distributed as follows: negative, 158 (72%), including 9 (4%) with bile; nasogastric aspiration aborted, 13 (6%); and positive, 49 (23%), including 4 (2%) that were strongly positive (> or =450 mL red blood). Test characteristics of nasogastric aspiration to detect upper gastrointestinal tract bleeding in 213 patients with a reference standard diagnosis were as follows: sensitivity 42% (95% CI 32% to 51%), specificity 91% (95% CI 83% to 95%), negative predictive value 64% (95% CI 56% to 71%), and positive predictive value 92% (95% CI 79% to 97%). The nasogastric aspiration accurately predicted the source of bleeding in 66% of patients (95% CI 59% to 72%). The likelihood ratio of a positive nasogastric aspiration was 11 (95% CI 4 to 30), and the likelihood ratio of a negative nasogastric aspiration was 0.6 (95% CI 0.5 to 0.7).

CONCLUSION

In patients without hematemesis, a positive nasogastric aspiration, seen in 23%, indicates probable upper gastrointestinal tract bleeding (LR+ 11), but a negative nasogastric aspiration, seen in 72%, provides little information (LR- 0.6).

摘要

研究目的

我们评估了在无呕血患者中，鼻胃管抽吸诊断上消化道出血的检测特征。

方法

在这项回顾性队列研究中，我们回顾了1997年至2002年间入住两家城市医院、因无呕血的胃肠道出血而入院患者的病历。鼻胃管抽吸结果阳性按出血严重程度分类，结果阴性按胆汁的有无分类。鼻胃管抽吸的参考标准是出院小结中出血的来源——上消化道与非上消化道。计算了比例的置信区间（CI）和似然比（LR）。

结果

在333例符合条件的患者中，235例接受了鼻胃管抽吸，220例接受了该项检查。220次检查结果分布如下：阴性，158例（72%），其中9例（4%）有胆汁；鼻胃管抽吸未成功，13例（6%）；阳性，49例（23%），其中4例（2%）为强阳性（≥450 mL红细胞）。以参考标准诊断的213例患者中，鼻胃管抽吸检测上消化道出血的检测特征如下：敏感性42%（95%CI 32%至51%），特异性91%（95%CI 83%至95%），阴性预测值64%（95%CI 56%至71%），阳性预测值92%（95%CI 79%至97%）。鼻胃管抽吸准确预测了66%患者的出血来源（95%CI 59%至72%）。鼻胃管抽吸结果阳性的似然比为11（95%CI 4至30），结果阴性的似然比为0.6（95%CI 0.5至0.7）。