Glasgow-Blatchford和Rockall评分系统对上消化道出血患者治疗的指导作用比较

目的：比较Glasgow-Blatchford和Rockall评分系统对上消化道出血患者治疗的指导作用。方法：回顾分析我院收治的上消化道出血病人共366例,详细记录每一位入组患者的临床表现、生命体征、实验室检查结果,根据Glasgow-Blatchford和Rockall评分系统的规则计算每一位患者的危险分值,并依据其分值将其分为低危组和高危组（Glasgow-Blatchford≥1分,Rockall≥1分）。结果：366例上消化道出血患者有243位（66.4%）经过补液、抑酸等保守治疗后出血停止,并按照临床实际将其定义为低危患者,Glasgow-Blatchford评分为0的低危患者有63位（17.2%）,Rockall评分为0的低危患者有99人（27.0%）,参照临床治疗中实际的高低危患者,计算得到Rockall评分系统对高危患者诊断的敏感性为87.0%,而Glasgow-Blatchford评分系统对高危患者诊断的敏感性为100%。Glasgow-Blatchford评分系统对上消化道出血高危患者诊断的敏感性明显高于临床Rockall评分系统。结论：基于实验室检查和临床表现的Glasgow-Blatchford评分,是一种简单、有效的判断上消化道出血严重程度的评分系统,有助于临床医师选择正确的治疗方案。

The Comparison of Glasgow-Blatchford and Rockall Ccoring Systems to Guidance for Patients with Upper Gastrointestinal Tract Bleeding

Objective： To compare the guidance of Glasgow-Blatchford and Rockall scoring systems for patients with upper gas-trointestinal tract bleeding（UGIB）.Methods： Retrospective study was done on patients（N=366） with UGIB admitted to The First Hospital of Huaian with Nanjing Medical University.Medical record data were abstracted by 1 research assistant blinded to the study purpose.Glasgow-Blatchford and Rockall scores were calculated for each enrolled patient.High risk was defined as a Glasgow-Blatchford score of greater than 0,a clinical Rockall score of greater than 0.Patients were defined as high-risk if they had a blood transfusion or any opera-tive or endoscopic intervention to control their bleeding.Results： In our total 366patients,243（66.4%） patients were categorized as those with low risk for clinical diagnosis in our study.The Glasgow-Blatchford score identified 63（17.2%） of the 366 patients as low-risk.The clinical Rockall score identified 99（27.0%） of the 366 patients as low-risk.Compared to the clinical diagnosis,the sensitivity of identify-ing high-risk cases with the Glasgow-Blatchford score was 100%,which was significantly greater than the clinical Rockall score with 87.0%.Conclusion： The Glasgow-Blatchford score,which is based on clinical and laboratory variables,may be a useful risk stratification tool in identifying high-risk patients with UGIB.