Mumtaz Khalid, Kamani Lubna, Hamid Saeed, Abid Shahab, Shah Hasnain A, Jafri Wasim
Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Karachi, Pakistan.
Indian J Gastroenterol. 2011 Mar;30(2):72-7. doi: 10.1007/s12664-011-0089-5. Epub 2011 May 17.
Upper gastrointestinal (UGI) bleeding carries high morbidity and mortality. The use of a bleeding care pathway (BCP) may improve outcomes, but the results are inconsistent in various studies.
A BCP for patients with UGI bleed with admission in a bleeding care unit (BCU) has been in use at our hospital since 2005. Prior to this, a high dependency unit was used for management of all emergencies including UGI bleeding. We compared the length of stay in the bleeding care/high dependency unit, total hospital stay, time to UGI endoscopy after admission, and survival between pre-2005 and post-2005 patients.
Five hundred and fifty-one patients were admitted with acute UGI bleed in the last 5 years; 121 belonged to pre-BCP (2004) period and 430 after implementation of the pathway (2005-2008). The mean (SD) time to UGI endoscopy improved from 21.3 (7.4) hours in the pre-BCU era to 9.4 (9.9) hours in BCU, p < 0.001. BCU stay was shorter from 2.41 (1.4) days pre-BCP to 1.93 (1.32) days post-BCP, (p < 0.001). The total hospital stay in pre-BCU (4.0 [2.08] days) as compared to BCU (4.13 [2.62] days; p = 0.58) was similar; there was no impact of BCU on survival.
A BCU implementation showed improvement in time to UGI endoscopy, and did not reduce BCU stay or impact survival.
上消化道（UGI）出血具有较高的发病率和死亡率。采用出血护理路径（BCP）可能会改善治疗结果，但在各项研究中结果并不一致。
自2005年起，我院开始对入住出血护理单元（BCU）的UGI出血患者采用BCP。在此之前，高依赖护理单元用于管理包括UGI出血在内的所有急症。我们比较了2005年前和2005年后患者在出血护理/高依赖护理单元的住院时间、总住院时间、入院后接受UGI内镜检查的时间以及生存率。
在过去5年中，共有551例患者因急性UGI出血入院；其中121例属于BCP实施前（2004年）时期，430例在路径实施后（2005 - 2008年）。UGI内镜检查的平均（标准差）时间从BCU建立前的21.3（7.4）小时改善至BCU时期的9.4（9.9）小时，p < 0.001。BCP实施前BCU住院时间为2.41（1.4）天，实施后为1.93（1.32）天，住院时间缩短，（p < 0.001）。BCU建立前的总住院时间为4.0（2.08）天，与BCU时期（4.13 [2.62]天；p = 0.58）相似；BCU对生存率没有影响。
实施BCU后，UGI内镜检查时间有所改善，但并未缩短BCU住院时间或影响生存率。
