Franco Matheus Cavalcante, Nakao Frank Shigueo, Rodrigues Rodrigo, Maluf-Filho Fauze, Paulo Gustavo Andrade de, Libera Ermelindo Della
Hospital Universitário, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
Departamento de Endoscopia, Fleury Medicina e Saúde, São Paulo, SP, Brasil.
Arq Gastroenterol. 2015 Dec;52(4):283-92. doi: 10.1590/S0004-28032015000400007.
Upper gastrointestinal bleeding implies significant clinical and economic repercussions. The correct establishment of the latest therapies for the upper gastrointestinal bleeding is associated with reduced in-hospital mortality. The use of clinical pathways for the upper gastrointestinal bleeding is associated with shorter hospital stay and lower hospital costs.
The primary objective is the development of a clinical care pathway for the management of patients with upper gastrointestinal bleeding, to be used in tertiary hospital.
It was conducted an extensive literature review on the management of upper gastrointestinal bleeding, contained in the primary and secondary information sources.
The result is a clinical care pathway for the upper gastrointestinal bleeding in patients with evidence of recent bleeding, diagnosed by melena or hematemesis in the last 12 hours, who are admitted in the emergency rooms and intensive care units of tertiary hospitals. In this compact and understandable pathway, it is well demonstrated the management since the admission, with definition of the inclusion and exclusion criteria, passing through the initial clinical treatment, posterior guidance for endoscopic therapy, and referral to rescue therapies in cases of persistent or rebleeding. It was also included the care that must be taken before hospital discharge for all patients who recover from an episode of bleeding.
The introduction of a clinical care pathway for patients with upper gastrointestinal bleeding may contribute to standardization of medical practices, decrease in waiting time for medications and services, length of hospital stay and costs.
上消化道出血具有重大的临床和经济影响。正确采用上消化道出血的最新治疗方法可降低住院死亡率。使用上消化道出血临床路径可缩短住院时间并降低住院费用。
主要目的是制定一种用于三级医院管理上消化道出血患者的临床护理路径。
对一级和二级信息来源中包含的上消化道出血管理进行了广泛的文献综述。
结果是为近期有出血证据、在过去12小时内通过黑便或呕血诊断、入住三级医院急诊室和重症监护病房的上消化道出血患者制定的临床护理路径。在这条紧凑且易懂的路径中，很好地展示了从入院开始的管理，包括纳入和排除标准的定义，经过初始临床治疗、内镜治疗的后续指导，以及在持续出血或再出血情况下转诊至抢救治疗。还包括了所有从出血发作中康复的患者出院前必须采取的护理措施。
引入上消化道出血患者临床护理路径可能有助于医疗实践的标准化，减少药物和服务的等待时间、住院时间和费用。
