Peninsula College of Medicine and Dentistry, Universities of Exeter and Plymouth, Truro, Cornwall, UK.
Eur J Gastroenterol Hepatol. 2012 Mar;24(3):288-93. doi: 10.1097/MEG.0b013e32834febef.
Acute upper gastrointestinal haemorrhage is a common medical emergency, initially managed with inpatient care. Bleeding stops spontaneously in over 80% of cases, indicating that patients with low-risk upper gastrointestinal haemorrhage may be more optimally managed in the community, without the need for admission to hospital.
To assess the safety of managing patients with low-risk upper gastrointestinal haemorrhage without admission to hospital.
Prospective/retrospective study of all patients presenting to a UK teaching hospital with low-risk upper gastrointestinal haemorrhage who were managed without admission to hospital over 5 years. Low risk was defined as Glasgow Blatchford Score of 2 or less, age below 70 years, no other active medical problems, not taking warfarin and suspected nonvariceal bleed. Outcome measures were the need for intervention (blood transfusion, endoscopic therapy or surgery) and death.
One hundred and forty-two patients fulfilled the inclusion criteria, and were managed without admission to hospital. No patients required endoscopic intervention, blood transfusion or surgery. The 28-day mortality was nil. Forty-one patients had normal endoscopic examination and 11 had significant endoscopic findings (peptic ulceration=10, oozing Mallory-Weiss tear=1) but did not require intervention.
Patients presenting with a primary upper gastrointestinal haemorrhage aged below 70 years with a Glasgow Blatchford Score of 2 or less are at a low risk, and can be safely managed in the community.
急性上消化道出血是一种常见的医疗急症，最初采用住院治疗。超过 80%的病例出血会自行停止，这表明低危上消化道出血患者可能更适合在社区进行管理，而无需住院治疗。
评估不将低危上消化道出血患者收入院管理的安全性。
对在英国一所教学医院就诊的 5 年内所有低危上消化道出血且未入院治疗的患者进行前瞻性/回顾性研究。低危定义为格拉斯哥布莱德福德评分（Glasgow Blatchford Score）为 2 或更低、年龄低于 70 岁、无其他活跃的医疗问题、未服用华法林且疑似非静脉曲张性出血。主要观察指标为需要干预（输血、内镜治疗或手术）和死亡。
符合纳入标准的患者共 142 例，未收入院治疗。无患者需要内镜介入、输血或手术。28 天死亡率为零。41 例患者内镜检查正常，11 例患者有明显的内镜发现（消化性溃疡=10 例，Mallory-Weiss 撕裂渗血=1 例），但无需干预。
年龄小于 70 岁且格拉斯哥布莱德福德评分为 2 或更低的原发性上消化道出血患者风险较低，可以在社区内安全地进行管理。
