Title: Upper GI Bleeding
题目：上消化道出血
Authors 作者: Mike Winters, MD, & Victoria Romaniuk, MD

I. What findings accurately predict UGI bleeding?
如何准确的诊断上消化道出血？
History of prior UGI bleed (likelihood ratio of >6), black stools or melena, Epigastric pain (likelihood ratio of 2.5), Detection of melena on rectal exam (likelihood ratio of 25), BUN:creatinine ratio >30
上消化道出血病史（可能系数大于6），黑便或柏油便，胃区痛，肛门指检时有柏油便（可能系数为25），BUN：肌酐比例大于30

II. What findings predict severe UGI bleeding?
如何判断严重上消化道出血？
Require emergent endoscopy, transfusion, emergent IR or surgical intervention, H/o cirrhosis, malignancy, or syncope, Unstable vital signs/shock (SBP <100, HR >100), Hgb <8 4. BUN >90
需要紧急内窥镜，输血，紧急放射介入，或手术的病人，肝硬化，肿瘤，晕厥病史，生命体征不稳定／休克（收缩压低于200，心率高于100），血红蛋白低于8.4，BUN高于90

III. Treatment of severe bleeding
大出血的治疗
a. Blood transfusion (consider massive transfusion protocol)
输血（考虑大输血方案）
b. Secure airway (consider ketamine)
保护气道（考虑用氯胺酮）
c. Medications: PPI (although no evidence for survival benefit); If suspect variceal bleeding: Octreotide (best evidence is for decreased transfusion requirement); Antibiotics (3rd generation cephalosporin or quinolone)
药物：质子泵抑制剂（虽然尚无有益于生存的证据）；如怀疑有静脉曲张出血，要用奥曲肽（最有力的证据是减少对输血的需求）；抗菌素（3代先锋或喹诺酮类）
d. Rally the troops (GI, IR, Surgery)!
召集队伍（胃肠科，放射介入，外科医生）！
e. Balloon tamponade device
气囊填塞设备

IV. Risk stratification for relatively minor UGI bleed
相对小量上消化道出血的危险因素分析
a. Glasgow-Blatchford bleeding score (GBS)
Glasgow-Blatchford出血分数（GBS）
i. http://www.mdcalc.com/glasgow-blatchford-bleeding-score-gbs/
ii. Questions: BUN, Hgb, sex, h/o CHF or hepatic disease, syncope, VS, presence of melena
计分项目：BUN，血红蛋白，性别，心衰，肝病，晕厥，生命体征，柏油便
iii. Score is useful only when zero (no deaths or subsequent interventions required)
分数只有为零时才有意义（没有死亡并不需要介入治疗）
iv. Does NOT require NG lavage
不需要放置胃管灌洗

V. BOTTOM LINE 要点
a. Best predictors of UGI bleeding are melena on rectal exam and BUN:creatinine ratio >30
判断上消化道出血的最好的指标是肛检有柏油便和BUN：肌酐比大于30
b. Treat severe bleeding aggressively, with transfusion, early activation of consultants, and placement of balloon tamponade device for refractory variceal bleeding
积极治疗大出血，包括输血，早期会诊，对顽固性曲张出血使用气囊填塞
c. Some patients with minor UGI bleeding can go home! Consider using a scoring system such as the GBS
有些小量出血的病人可以回家！要参考用GBS一类的评分系统
d. It’s OK to put NG tubes in patients with varices, but overall NG tubes are not all that helpful
有静脉曲张的病人可以放胃管，但总的来讲帮助不大

References 参考文献:
1. Srygley FD, Gerardo CJ, Tran T, Fisher DA. Does This Patient Have a Severe Upper Gastrointestinal Bleed? JAMA. 2012;307(10):1072-1079.
2. Ali H, Lang E, Barkan A. Emergency department risk stratification in upper gastrointestinal bleeding. CJEM. 2012 Jan;14(1):45-49.