Effect of emergency fast-track treatment on dangerous upper gastrointestinal bleeding_West China Medical Journal

Authors：

XU Pengjie ¹ , WU Xiaoling ² , XU Guisen ¹ , XU Zhaoxia ¹ ,  WANG Ping ¹

1. Department of Emergency, the General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P. R. China;
2. Department of Gastroenterology, the General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P. R. China;

Corresponding?author：

WANG Ping, Email: 282210437@qq.com

Keywords：

Dangerous upper gastrointestinal bleeding; fast-track treatment; multidisciplinary therapy

DOI：

10.7507/1002-0179.202112127

Video：

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Objective To investigate the effect of emergency fast-track treatment on dangerous upper gastrointestinal bleeding. Methods Seventy-six patients who received traditional treatment between October 2020 and March 2021 were included in the traditional treatment group, and 82 patients who entered the emergency fast track for dangerous upper gastrointestinal bleeding between April 2021 and September 2021 were included in the fast-track treatment group. The patients in the traditional treatment group were treated with the traditional single-subject diagnosis and treatment mode, and the patients in the fast-track treatment group were treated according to the multidisciplinary diagnosis and treatment procedures of emergency fast track for dangerous upper gastrointestinal bleeding. The length of emergency stay, 24-hour endoscopic completion rate, effective rate, and length of hospital stay were compared between the two groups. Results The length of emergency stay [(3.75±3.19) vs. (6.51±4.72) h], the effective rate (96.3% vs. 85.5%) and the length of hospital stay [(8.26±2.51) vs. (11.07±2.79) d] were significantly better in the fast-track group than those in the traditional treatment group (P<0.05). There was no significant difference in the 24-hour endoscopic completion rate between the two groups (96.3% vs. 96.1%, P>0.05). Conclusion Compared with the traditional treatment mode, the fast-track treatment mode can significantly improve the treatment efficiency, and reduce the lengths of emergency stay and hospital stay.

Citation： XU Pengjie, WU Xiaoling, XU Guisen, XU Zhaoxia, WANG Ping. Effect of emergency fast-track treatment on dangerous upper gastrointestinal bleeding. West China Medical Journal, 2022, 37(11): 1636-1640. doi: 10.7507/1002-0179.202112127 Copy

1.	Antunes C, Copelin IE. Upper gastrointestinal bleeding. Treasure Island (FL): StatPearls Publishing, 2020.
2.	中國醫師協會急診醫師分會, 中華醫學會急診醫學分會, 全軍急救醫學專業委員會, 等. 急性上消化道出血急診診治流程專家共識. 中國急救醫學, 2021, 41(1): 1-10.
3.	胡佳辰. 危險性消化道出血的急診臨床診治與臨床思維. 中國急救醫學, 2017, 37(5): 467-471.
4.	Laursen SB, Dalyon HR, Murray IA, et al. Performance of new thresholds of the Glasgow Blatchford score in managing patients with upper gastrointestinal bleeding. Clin Gastroenterol Hepatol, 2015, 13(1): 115-121.
5.	李玥, 胡祥鵬, 章禮久. 三種內鏡前評分系統對危險性急性上消化道出血預后評估的比較. 蚌埠醫學院學報, 2022, 47(8): 1026-1029.
6.	杜小芳, 何旭. 不同年齡上消化道出血的臨床特征及其危險因素比較分析. 內蒙古醫科大學學報, 2021, 43(1): 62-64, 81.
7.	《中華內科雜志》, 《中華醫學雜志》, 《中華消化雜志》, 等. 急性非靜脈曲張性上消化道出血診治指南(2018 年,杭州). 中華消化內鏡雜志, 2019, 36(2): 77-85.
8.	岳佳琪, 李莉, 陳跡. 艾司奧美拉唑鈉治療上消化道出血的成本-效果分析. 西北藥學雜志, 2021, 36(6): 1009-1012.
9.	董麗麗, 周榮斌. 急性上消化道出血救治研究現狀. 中國實用內科雜志, 2021, 41(3): 203-208.
10.	李心群, 陳心怡, 王欣璐, 等. 危險性上消化道出血患者病情嚴重程度危險因素分析及預警評估模型構建. 中華急診醫學雜志, 2022, 31(4): 539-543.
11.	喬麗, 程績, 鄭暉, 等. 基于傾向性評分匹配分析急診快速通道救治急性上消化道出血的療效. 中國急救醫學, 2022, 42(4): 326-330.
12.	李福娥. 優化急診護理流程在危險性急性上消化道出血中的應用. 實用中西醫結合臨床, 2020, 20(7): 134-135.
13.	張朝輝, 嚴晶晶. 危險性上消化道出血多學科協作診療模式與傳統會診模式臨床療效的對照研究. 中華危重病急救醫學, 2020, 32(9): 1107-1110.
14.	涂家紅, 張明清, 趙斌. 危險性急性上消化道出血 141 例臨床診治分析. 中華急診醫學雜志, 2018, 27(5): 518-523.
15.	Barkun AN, Almadi M, Kuipers EJ, et al. Management of non-variceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med, 2019, 171(11): 805-822.
16.	Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ, 2019, 364: 1536.
17.	周未, 樊麗珍, 楊保元, 等. 急診胃鏡微創治療消化道大出血 219 例分析. 中國藥物與臨床, 2020, 20(12): 1975-1977.
18.	Jeong N, Kim KS, Jung YS, et al. Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhage. Am J Emerg Med, 2019, 37(2): 277-280.
19.	Tandberg DJ, Smith TP, Suhocki PV, et al. Early outcomes of empiric embolization of tumor-related gastrointestinal hemorrhage in patients with advanced malignancy. J Vasc Interv Radiol, 2012, 23: 1445-1452.
20.	楊麗. 急性上消化道大出血介入治療現狀. 四川大學學報(醫學版), 2022, 53(3): 361-366.

1. Antunes C, Copelin IE. Upper gastrointestinal bleeding. Treasure Island (FL): StatPearls Publishing, 2020.
2. 中國醫師協會急診醫師分會, 中華醫學會急診醫學分會, 全軍急救醫學專業委員會, 等. 急性上消化道出血急診診治流程專家共識. 中國急救醫學, 2021, 41(1): 1-10.
3. 胡佳辰. 危險性消化道出血的急診臨床診治與臨床思維. 中國急救醫學, 2017, 37(5): 467-471.
4. Laursen SB, Dalyon HR, Murray IA, et al. Performance of new thresholds of the Glasgow Blatchford score in managing patients with upper gastrointestinal bleeding. Clin Gastroenterol Hepatol, 2015, 13(1): 115-121.
5. 李玥, 胡祥鵬, 章禮久. 三種內鏡前評分系統對危險性急性上消化道出血預后評估的比較. 蚌埠醫學院學報, 2022, 47(8): 1026-1029.
6. 杜小芳, 何旭. 不同年齡上消化道出血的臨床特征及其危險因素比較分析. 內蒙古醫科大學學報, 2021, 43(1): 62-64, 81.
7. 《中華內科雜志》, 《中華醫學雜志》, 《中華消化雜志》, 等. 急性非靜脈曲張性上消化道出血診治指南(2018 年,杭州). 中華消化內鏡雜志, 2019, 36(2): 77-85.
8. 岳佳琪, 李莉, 陳跡. 艾司奧美拉唑鈉治療上消化道出血的成本-效果分析. 西北藥學雜志, 2021, 36(6): 1009-1012.
9. 董麗麗, 周榮斌. 急性上消化道出血救治研究現狀. 中國實用內科雜志, 2021, 41(3): 203-208.
10. 李心群, 陳心怡, 王欣璐, 等. 危險性上消化道出血患者病情嚴重程度危險因素分析及預警評估模型構建. 中華急診醫學雜志, 2022, 31(4): 539-543.
11. 喬麗, 程績, 鄭暉, 等. 基于傾向性評分匹配分析急診快速通道救治急性上消化道出血的療效. 中國急救醫學, 2022, 42(4): 326-330.
12. 李福娥. 優化急診護理流程在危險性急性上消化道出血中的應用. 實用中西醫結合臨床, 2020, 20(7): 134-135.
13. 張朝輝, 嚴晶晶. 危險性上消化道出血多學科協作診療模式與傳統會診模式臨床療效的對照研究. 中華危重病急救醫學, 2020, 32(9): 1107-1110.
14. 涂家紅, 張明清, 趙斌. 危險性急性上消化道出血 141 例臨床診治分析. 中華急診醫學雜志, 2018, 27(5): 518-523.
15. Barkun AN, Almadi M, Kuipers EJ, et al. Management of non-variceal upper gastrointestinal bleeding: guideline recommendations from the International Consensus Group. Ann Intern Med, 2019, 171(11): 805-822.
16. Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. BMJ, 2019, 364: 1536.
17. 周未, 樊麗珍, 楊保元, 等. 急診胃鏡微創治療消化道大出血 219 例分析. 中國藥物與臨床, 2020, 20(12): 1975-1977.
18. Jeong N, Kim KS, Jung YS, et al. Delayed endoscopy is associated with increased mortality in upper gastrointestinal hemorrhage. Am J Emerg Med, 2019, 37(2): 277-280.
19. Tandberg DJ, Smith TP, Suhocki PV, et al. Early outcomes of empiric embolization of tumor-related gastrointestinal hemorrhage in patients with advanced malignancy. J Vasc Interv Radiol, 2012, 23: 1445-1452.
20. 楊麗. 急性上消化道大出血介入治療現狀. 四川大學學報(醫學版), 2022, 53(3): 361-366.

West China Medical Journal

Effect of emergency fast-track treatment on dangerous upper gastrointestinal bleeding

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