Department of Surgery, University of Calgary, Tom Baker Cancer Center, Education Office TBCC110D, 1331 - 29 St. NW, Calgary, AB, Canada, T2N 4N2.
Int J Surg. 2011;9(1):83-5. doi: 10.1016/j.ijsu.2010.09.011. Epub 2010 Oct 14.
Diverticular disease is a common cause for lower gastrointestinal bleeding. Although the hemorrhage often resolves spontaneously, some patients will require massive transfusions and emergency surgery. In this study we report risk factors predictive of severe diverticular bleeds.
We completed a retrospective analysis of 99 patients, admitted with lower gastrointestinal bleeding and colonoscopic evidence of diverticulosis and no other cause of the hemorrhage between January 1995 and December 2005. A database was generated and univariate and multivariate analyses were carried out.
Of the 99 patients, 23 patients were classified as having a severe bleed defined as having a systolic blood pressure below 90 mm Hg, requirement for more than 6 units of transfusion, or emergent surgery. Multiple logistic regression showed that the initial hemoglobin (p = 0.001), INR ≥ 1.5 (p = 0.003), initial diastolic blood pressure (p = 0.024), initial heart rate (p = 0.047), and blood pressure medications (p = 0.049) predicted severe diverticular hemorrhage.
The identified predictor variables are all quantifiable at the time of initial presentation, and these may help identify severe cases of diverticular bleeding requiring urgent management.
憩室病是下消化道出血的常见原因。尽管出血通常会自行缓解，但有些患者需要大量输血和紧急手术。本研究报告了预测严重憩室出血的危险因素。
我们对 1995 年 1 月至 2005 年 12 月期间因下消化道出血和结肠镜检查证实有憩室病且无其他出血原因而入院的 99 例患者进行了回顾性分析。生成了一个数据库，并进行了单因素和多因素分析。
99 例患者中，23 例被归类为严重出血，定义为收缩压<90mmHg、需要输注超过 6 单位的血或紧急手术。多变量逻辑回归显示，初始血红蛋白（p=0.001）、INR≥1.5（p=0.003）、初始舒张压（p=0.024）、初始心率（p=0.047）和血压药物（p=0.049）预测了严重憩室出血。
所确定的预测变量在初始表现时均可量化，这些变量可能有助于识别需要紧急处理的严重憩室出血病例。
