中国急救医学
中國急救醫學
중국급구의학
CHINESE JOURNAL OF CRITICAL CARE MEDICINE
2014年
11期
1009-1012
,共4页
王安秀%杨耀鹏%吴玉怀%刘建平%戴晓倩
王安秀%楊耀鵬%吳玉懷%劉建平%戴曉倩
왕안수%양요붕%오옥부%류건평%대효천
急性消化道出血%休克指数( SI)%老年患者
急性消化道齣血%休剋指數( SI)%老年患者
급성소화도출혈%휴극지수( SI)%노년환자
Acute gastrointestinal bleeding%Shock index ( SI)%Older patients
目的通过分析老年、非老年急性消化道出血患者休克指数（ SI）的变化，寻找不同年龄组急性消化道出血患者SI的最佳诊断切点。方法回顾2013-01～2014-01收治消化内科疑似急性消化道出血的患者，收集入院时监测的各项生命体征、年龄和性别资料。计算患者的SI值，并按照是否＞65岁划分为老年组和非老年组，进行SI的差异性分析。结果共收集200例疑似急性消化道出血患者的资料，急性消化道出血患者46例。非老年组80例，其中急性消化道出血患者17例；老年组120例，急性消化道出血患者29例；按照标准的SI切点（SI＞0．90）被认为存在急性消化道出血，敏感度（Sens）65．2％，特异度（Spec）87．7％，约登指数（Youden’s）52.9％；老年组更低的SI切点（ SI≥0．80：Sens 79．3％，Spec 90．1％、Youden’ s 69．4％）对判断急性消化道出血更好，可以减少漏诊率。结论更低的SI切点（ SI≥0．8）能更早识别老年患者急性消化道出血，提前做好抢救准备。
目的通過分析老年、非老年急性消化道齣血患者休剋指數（ SI）的變化，尋找不同年齡組急性消化道齣血患者SI的最佳診斷切點。方法迴顧2013-01～2014-01收治消化內科疑似急性消化道齣血的患者，收集入院時鑑測的各項生命體徵、年齡和性彆資料。計算患者的SI值，併按照是否＞65歲劃分為老年組和非老年組，進行SI的差異性分析。結果共收集200例疑似急性消化道齣血患者的資料，急性消化道齣血患者46例。非老年組80例，其中急性消化道齣血患者17例；老年組120例，急性消化道齣血患者29例；按照標準的SI切點（SI＞0．90）被認為存在急性消化道齣血，敏感度（Sens）65．2％，特異度（Spec）87．7％，約登指數（Youden’s）52.9％；老年組更低的SI切點（ SI≥0．80：Sens 79．3％，Spec 90．1％、Youden’ s 69．4％）對判斷急性消化道齣血更好，可以減少漏診率。結論更低的SI切點（ SI≥0．8）能更早識彆老年患者急性消化道齣血，提前做好搶救準備。
목적통과분석노년、비노년급성소화도출혈환자휴극지수（ SI）적변화，심조불동년령조급성소화도출혈환자SI적최가진단절점。방법회고2013-01～2014-01수치소화내과의사급성소화도출혈적환자，수집입원시감측적각항생명체정、년령화성별자료。계산환자적SI치，병안조시부＞65세화분위노년조화비노년조，진행SI적차이성분석。결과공수집200례의사급성소화도출혈환자적자료，급성소화도출혈환자46례。비노년조80례，기중급성소화도출혈환자17례；노년조120례，급성소화도출혈환자29례；안조표준적SI절점（SI＞0．90）피인위존재급성소화도출혈，민감도（Sens）65．2％，특이도（Spec）87．7％，약등지수（Youden’s）52.9％；노년조경저적SI절점（ SI≥0．80：Sens 79．3％，Spec 90．1％、Youden’ s 69．4％）대판단급성소화도출혈경호，가이감소루진솔。결론경저적SI절점（ SI≥0．8）능경조식별노년환자급성소화도출혈，제전주호창구준비。
Objective By analyzing changes of shock index ( SI ) for acute gastrointestinal bleeding in different age groups, to explore the clinical significance of SI for acute gastrointestinal bleeding, and find the best cutoff point of SI in different age groups.Methods From April 2013 to April 2014, we enrolled 200 patients with suspected acute gastrointestinal bleeding, and collected vital signs, age and gender of the patients at admission.SI is the mathematical relationship of the heart rate divided by the systolic blood pressure; the SI formula was applied to their initial hospital vital signs. Patients were further subdivided by age.SI difference analysis was performed in different age groups. Results We collected 200 patients of suspected acute upper gastrointestinal bleeding ( 80 patients in non-elderly group, 120 patients in elderly group ) , included 46 patients with acute gastrointestinal bleeding (17 patients in non-elderly group, 29 patients in elderly group).Across our dataset, using the standard SI cutoff of >0.90 as the threshold for bleeding, the sensitivity is 65.2%, the specificity is 87.7%, with a Youden's index of 52.9%.Lowering the SI to≥0.80 in elderly group increases the sensitivity to 79.3%, the specificity is 90.1%, with a Youden's index of 69.4%.Conclusion SI, at a lowered threshold of≥0.80, can be used to identify older patients with acute gastrointestinal bleeding that will require intervention for hemostasis.
