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[JAMA临床指南精要]:急性下消化道出血患者的诊治
2018年07月17日 指南导读, 进展交流 暂无评论

JAMA Clinical Guidelines Synopsis

July 3, 2018

Management of Patients With Acute Lower Gastrointestinal Tract Bleeding

Neil Sengupta, Adam S. Cifu

JAMA. 2018;320(1):86-87.

doi:10.1001/jama.2018.5684

Guideline title 指南题目

ACG Clinical Guideline: Management of Patients With Acute Lower Gastrointestinal Bleeding

ACG临床指南:急性下消化道出血患者的诊治

Release date 发布日期

March 1, 2016

2016年3月1日

Funding source 资助来源

American College of Gastroenterology (ACG), National Institutes of Health

Target population 目标人群

Adult patients hospitalized with acute lower gastrointestinal (GI) tract bleeding

急性下消化道出血的成年住院患者

Major recommendations 主要推荐意见

For patients with hematochezia associated with hemodynamic instability, an initial upper endoscopy should be performed. A nasogastric aspirate/lavage may be used to assess a possible upper GI tract source if suspicion of upper GI tract bleeding is moderate (strong recommendation; weak evidence).

对于伴随血流动力学不稳定的便血患者,应当进行上消化道内镜检查。如果怀疑患者为上消化道出血,应通过鼻胃管引流或冲洗评估可能的出血来源

In the absence of hemodynamic instability, colonoscopy should be the initial diagnostic procedure for nearly all patients presenting with acute lower GI tract bleeding (strong recommendation; weak evidence).

对于几乎所有不伴随血流动力学不稳定的急性上消化道出血患者,结肠镜检查应当作为初始的诊断措施

Anticoagulation reversal agents should be considered before endoscopy in patients with an international normalized ratio (INR) greater than 2.5. Endoscopic treatment may be considered in patients with an INR of 1.5 to 2.5 before or concomitant with administration of reversal agents (conditional recommendation; very weak evidence).

如果INR > 2.5,进行内镜检查前应考虑使用抗凝逆转药物。如果INR 1.5-2.5,则在药物逆转前或同时,可考虑进行内镜下治疗

In patients with markers of hemodynamic instability at presentation, significant comorbid disease, anemia, and signs or symptoms of ongoing bleeding, a rapid bowel preparation should be initiated following hemodynamic resuscitation and a colonoscopy performed within 24 hours (conditional recommendation; weak evidence).

若患者就诊时即出现血流动力学不稳定表现,或具有非常严重的合并症,贫血,持续出血的症状或体征,则在复苏治疗后应迅速开始进行肠道准备,并在24小时内进行结肠镜检查

Radiographic interventions (tagged red blood cell scintigraphy, computed tomographic angiography, and angiography) should be considered in high-risk patients with ongoing bleeding who do not respond adequately to resuscitation and who are unlikely to tolerate bowel preparation and colonoscopy (strong recommendation; very weak evidence).

对复苏治疗反应不佳的持续出血高危患者,或不能耐受肠道准备及结肠镜检查的患者,应考虑进行影像学检查或治疗(标记红细胞显影,CT血管造影,血管造影)。

To prevent recurrent bleeding, nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided, particularly if bleeding is secondary to diverticulosis or angioectasias. In patients with established high-risk cardiovascular disease, aspirin for secondary prevention should not be discontinued (strong recommendation; weak evidence).

为预防再次出血,应避免使用阿司匹林以外的非甾体抗炎药,尤其对于继发于憩室或血管扩张的出血患者。对于明确的心血管疾病高危患者,不应停用阿司匹林等二级预防药物

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