Division of Gastroenterology AO San Camillo Forlanini, Circonvallazione gianicolense 87, 00152 Rome, Italy.
Dig Liver Dis. 2010 Sep;42(9):629-34. doi: 10.1016/j.dld.2010.03.012. Epub 2010 Jun 19.
To analyze the effects of endoscopy and care in a gastroenterology ward on 30-day mortality among Italian patients hospitalized for acute non-variceal upper gastrointestinal hemorrhage (UGIH).
We conducted a population-based study based on administrative data contained in the Regional Hospital Information System (RHIS) for the Lazio Region (Italy). We identified all hospitalizations with a main diagnosis of UGIH during period 2000-2005. Discharge data were analyzed for procedures performed, ward where the patient was cared for, comorbidities, vital status at discharge. Vital status 30 days after admission was cross-checked with the Regional Registry of Causes of Death. Logistic regression models were performed taking into account patients' risk factors (OR and C.I. 95%).
A total of 13,427 hospitalizations for UGIH (mean patient age, 68 years; 60% males) were identified. The 30-day mortality was 6.9%. Significantly lower rates were observed among hospitalizations that included endoscopy (OR 0.30, 95% C.I. 0.26-0.34), specialist care (OR 0.55, 95% C.I. 0.37-0.82), or both (OR 0.12, 95% C.I. 0.07-0.22). The protective effects of endoscopy and specialist care remained strong after adjustment for potential risk factors.
Endoscopy, per se, reduces mortality among patients hospitalized for UGIH, and care in a gastroenterology ward may offer additional protective effects.
分析意大利急性非静脉曲张性上消化道出血（UGIH）住院患者内镜和消化内科护理对 30 天死亡率的影响。
我们基于意大利拉齐奥地区区域医院信息系统（RHIS）中的行政数据进行了一项基于人群的研究。我们确定了 2000-2005 年期间所有以 UGIH 为主要诊断的住院病例。对患者接受的操作、护理的病房、合并症、出院时的生命状态进行出院数据分析。通过与区域死因登记处交叉核对，确定入院后 30 天的生命状态。使用逻辑回归模型考虑患者的危险因素（比值比和 95%置信区间）。
共确定了 13427 例 UGIH 住院病例（平均患者年龄为 68 岁，男性占 60%）。30 天死亡率为 6.9%。内镜检查（比值比 0.30，95%置信区间 0.26-0.34）、专科护理（比值比 0.55，95%置信区间 0.37-0.82）或两者均包含的住院病例的死亡率显著较低。在调整了潜在危险因素后，内镜检查和专科护理的保护作用仍然很强。
内镜检查本身可降低 UGIH 住院患者的死亡率，消化内科护理可能提供额外的保护作用。
