以多学科协作为导向的重症上消化道大出血的急诊综合治疗
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摘要
目的:探讨多学科协作诊疗(MDT)模式在急诊上消化道大出血诊治中的应用。方法:回顾性分析2015-01-01—2016-12-31期间于我院急诊监护室(EICU)接受MDT模式治疗的上消化道大出血患者104例,对该群患者的病例特点、预后情况等进行分析。结果:本次研究中上消化道出血最常见的病因为食管胃底静脉曲张破裂(35.58%)及消化性溃疡(34.62%),采用MDT策略后,79.17%的患者在入院24h内完成内镜检查(治疗),最终92例(88.46%)患者治愈出院,平均住院时间(12.93±8.34)d。结论:MDT策略的实施可提高上消化道大出血患者的诊疗效率,降低患者死亡风险。
Objective:To explore the application of multidisciplinary treatment(MDT)mode in the diagnosis and treatment of severe upper gastrointestinal bleeding.Method:A retrospective analysis of 104 patients with severe upper gastrointestinal bleeding who accepted MDT mode in our Emergency Intensive Care Unit(EICU)from January 1,2015 to December 31,2016 was conducted.The patient's characteristics and prognosis were analyzed.Result:The most common causes of severe upper gastrointestinal bleeding in this study were rupture of esophageal/gastric varies(35.58%)and peptic ulcer(34.62%).After the application of MDT mode,79.17% of patients completed the endoscopic examination or treatment in 24 hours.Eventually,92patients(88.46%)were cured and discharged.The average days of hospitalization were(12.93 ± 8.34)days.Conclusion:The implementation of MDT mode can improve the efficacy of the diagnosis and treatment of severe upper gastrointestinal bleeding patients and reduce the risk of mortality.
Objective:To explore the application of multidisciplinary treatment(MDT)mode in the diagnosis and treatment of severe upper gastrointestinal bleeding.Method:A retrospective analysis of 104 patients with severe upper gastrointestinal bleeding who accepted MDT mode in our Emergency Intensive Care Unit(EICU)from January 1,2015 to December 31,2016 was conducted.The patient's characteristics and prognosis were analyzed.Result:The most common causes of severe upper gastrointestinal bleeding in this study were rupture of esophageal/gastric varies(35.58%)and peptic ulcer(34.62%).After the application of MDT mode,79.17% of patients completed the endoscopic examination or treatment in 24 hours.Eventually,92patients(88.46%)were cured and discharged.The average days of hospitalization were(12.93 ± 8.34)days.Conclusion:The implementation of MDT mode can improve the efficacy of the diagnosis and treatment of severe upper gastrointestinal bleeding patients and reduce the risk of mortality.
引文
[1]赵蕊,张丽瑶,吴云海,等.45例多学科协作抢救急性上消化道大出血患者的临床分析[J].中华急诊医学杂志,2014,23(11):1268-1270.
[2]徐小元,丁惠国,贾继东,等.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,55(2):203-219.
[3]中华医学会消化内镜学分会.急性非静脉曲张性上消化道出血诊治指南(2015年,南昌)[J].中华医学杂志,2016,96(4):254-259.
[4] Jairath V,Kahan BC,Stanworth SJ,et al.Prevalence,management,and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding in the United Kingdom[J].Transfusion,2013,53(5):1069-1076.
[5]中国医师协会急诊医师分会.急性上消化道出血急诊诊治流程专家共识[J].中国急救医学,2015,35(10):865-873.
[6]王家祥,苟建军,赵菁.综合医院多学科协作在疾病诊治中的实践与作用[J].医学与哲学(B),2015,36(9):1-4.
[7]钟爱丽,叶琳,温德树,等.消化科整合医学模式对消化性溃疡合并大出血救治效果的影响[J].中国医疗管理科学,2017,7(5):55-58.
[8]叶璐,吕菁君,魏捷.走好中庸之道——急性冠状动脉综合征合并消化道出血的急诊诊治策略[J].临床急诊杂志,2016,17(8):654-658.
[2]徐小元,丁惠国,贾继东,等.肝硬化门静脉高压食管胃静脉曲张出血的防治指南[J].临床肝胆病杂志,2016,55(2):203-219.
[3]中华医学会消化内镜学分会.急性非静脉曲张性上消化道出血诊治指南(2015年,南昌)[J].中华医学杂志,2016,96(4):254-259.
[4] Jairath V,Kahan BC,Stanworth SJ,et al.Prevalence,management,and outcomes of patients with coagulopathy after acute nonvariceal upper gastrointestinal bleeding in the United Kingdom[J].Transfusion,2013,53(5):1069-1076.
[5]中国医师协会急诊医师分会.急性上消化道出血急诊诊治流程专家共识[J].中国急救医学,2015,35(10):865-873.
[6]王家祥,苟建军,赵菁.综合医院多学科协作在疾病诊治中的实践与作用[J].医学与哲学(B),2015,36(9):1-4.
[7]钟爱丽,叶琳,温德树,等.消化科整合医学模式对消化性溃疡合并大出血救治效果的影响[J].中国医疗管理科学,2017,7(5):55-58.
[8]叶璐,吕菁君,魏捷.走好中庸之道——急性冠状动脉综合征合并消化道出血的急诊诊治策略[J].临床急诊杂志,2016,17(8):654-658.