【摘要】 目的观察Forrest分级和Rockall评分对消化性溃疡大出血患者预后的判断价值。方法选取2006年9月～2009年8月在我院住院治疗的221例确诊为消化性溃疡大出血患者,入院后给予药物治疗及内镜下治疗。治疗药物的选择、治疗时机及内镜下治疗方式的选择无显著性差异。平均随访时间为5个月(0～12个月)。按照Forrest分级,Rockall评分对患者再出血发生率及死亡率分别进行评估。按Forrest分级,Ⅰa 33例,Ⅰb 79例,Ⅱa 63例,Ⅱb 37例,Ⅱc 9例;按Rockall评分,0分者6例,1分者7例,2分者11例,3分者27例,4分者21例,5分者45例,6分者40例,7分者34例,8分者17例,>8者13例。结果按Forrest分级,Forrest分级Ⅰa级者再出血率为84.85%(28/33),Ⅰb级者再出血率为51.90%(41/79),Ⅱa级者再出血率为39.68%(25/63),Ⅱb级者再出血率为21.62%(8/37),Ⅱc级者再出血率为11.11%(1/9)(P<0.05)。按Rockall评分分组,Rockall评分0～2分者无死亡;3～4分者无死亡;5分者无死亡;评分6分者死亡率2.50%(1/19);评分7分者死亡率5.88%(2/34);评分8分者死亡率23.53%(4/17);评分>8分者死亡率69.23%(9/13)(P<0.05)。结论对于消化性溃疡大出血患者,Forrest分级与再出血发生率有相关性,适用于临床及胃镜下作为选择止血方法的依据;而Rockall评分则与死亡率有相关性,适合于临床作为判断患者死亡风险的依据,并进而指导临床治疗方案的选择。更多还原

【Abstract】 Objective To investigate the predictive value of Forrest classification and Rockall score to prognosis of severe peptic ulcer bleeding patients in accessing rebleeding rate and mortality rate.Methods Two hundred and twenty-one inpatients in this hospital from September 2006 to August 2009,whose diagnosis was severe peptic ulcer bleeding,were given different medical and endoscopic treatment without significant differenee.They were followed up for mean 5 months(0-12 months),then were accessed by Forrest classification and Rockall score separately.By Forrest classification,there were 33,79,63,37,9 patients in grade Ⅰa,Ⅰb,Ⅱa,Ⅱb,Ⅱc respectively;and by Rockall score,there were 6,7,11,27,21,45,40,34,17,13 patients with score of 0,1,2,3,4,5,6,7,8,>8 respectively.The rebleeding rate and mortality rate were observed.Results Rebleeding rate of Forrest Ⅰa grade was 84.85%(28/33),Forrest Ⅰb grade was 51.90%(41/79),Forrest Ⅱa grade was 39.68%(25/63),Forrest Ⅱb grade was 21.62%(8/37),Forrest Ⅱc grade was 11.11%(1/9)(P<0.05).Mortality rate of patients with Rockall score ranged 0 to 2 was 0,Rockall score ranged 3 to 4 middle-risk group was 0,Rockall score 5 was 0,Rockall score 6 was 2.50%(1/19),Rockall score 7 group was 5.88%(2/34),Rockall score 8 group was 23.53%(4/17),Rockall score above 8 group was 69.23%(9/13)(P<0.05).Conclusion For severe peptic ulcer bleeding patients,Forrest classification correlates with rebleeding rate,which is suitable to help to select clinical and endoscopic methods of treatment.Rockall score correlates with mortality rate,which is suitable to help to prediction the risk of death,and then guides the clinical treatment.更多还原