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格拉斯哥-布拉奇福德评分在血液透析患者早期风险评估中的有效性。

The effectiveness of Glasgow-Blatchford Score in early risk assessment of hemodialysis patients.

作者信息

Satılmış Dilay, Yavuz Burcu Genc, Güven Oya, Güven Ramazan, Cander Başar

机构信息

Department of Emergency Medicine, University of Health Sciences Sultan 2 Abdülhamid Han Training and Research Hospital, Istanbul, Turkey.

Department of Emergency Medicine, University of Health Sciences Haydarpaşa Numune Training and Research Hospital, Istanbul, Turkey.

出版信息

Intern Emerg Med. 2022 Apr;17(3):753-759. doi: 10.1007/s11739-021-02869-8. Epub 2021 Oct 15.

Abstract

In the emergency departments (ED), the incidence of admission is increasing gradually due to gastrointestinal system (GIS) complications of hemodialysis (HD) patients. With this increasing number of patients, there are many classification systems developed in early risk assessment before endoscopy. In this study, we aimed to evaluate the Glasgow-Blatchford Score's (GBS) effectiveness in HD patients with suspected GIS hemorrhage in the ED.The files of 169 patients who received HD treatment were retrospectively reviewed. 64 patients who were examined and treated for reasons other than GIS hemorrhage in the ED were excluded, and the files of a total of 105 were analyzed retrospectively. The demographic characteristics and laboratory values of the patients were recorded from the patient files. When the patients were evaluated according to GBS parameters, a significant difference was found between the two groups in terms of pulse pressure, systolic blood pressure, hemoglobin value, melena, and accompanying comorbid diseases (p < 0.05). Of the 16 patients who presented to the ED due to syncope, 2 were in the GIS hemorrhage (+) group, and 14 patients were in the control group. In this study, we aimed to show that the increase in the number of admissions in the ED due to complications secondary to HD treatment and the accompanying serious changes in laboratory parameters may cause misleading results in patients with suspected GIS hemorrhage, and it is necessary to plan comprehensive and multi-center studies on new alternative scoring systems to GBS in specific patient groups such as HD patients.

摘要

在急诊科,由于血液透析(HD)患者的胃肠道系统(GIS)并发症,住院率正逐渐上升。随着此类患者数量的增加,在内镜检查前的早期风险评估中已开发出多种分类系统。在本研究中,我们旨在评估格拉斯哥 - 布拉奇福德评分(GBS)在急诊科疑似GIS出血的HD患者中的有效性。对169例接受HD治疗的患者病历进行回顾性分析。排除64例在急诊科因GIS出血以外原因接受检查和治疗的患者,共对105例患者的病历进行回顾性分析。从患者病历中记录患者的人口统计学特征和实验室值。根据GBS参数对患者进行评估时,两组在脉压、收缩压、血红蛋白值、黑便及伴发的合并症方面存在显著差异(p < 0.05)。因晕厥就诊于急诊科的16例患者中,2例在GIS出血(+)组,14例在对照组。在本研究中,我们旨在表明,HD治疗继发并发症导致急诊科住院人数增加以及实验室参数随之出现的严重变化,可能会在疑似GIS出血的患者中产生误导性结果,因此有必要针对HD患者等特定患者群体,就GBS的新替代评分系统开展全面的多中心研究。

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