fa مقایسه دقت تشخیصی پرسشنامه‌های گلسگو-بلچفورد اسکور و روکال اسکور کامل و بالینی دربیماران با خونریزی گوارشی فوقانی حاد داخلی Internal medicine پژوهشي-کامل Research(Original) <span style="font-size:medium"><span new="" roman="" style="font-family:" times=""><span style="color:#000000"><span style="font-style:normal"><span style="font-weight:normal"><span style="white-space:normal"><span style="text-decoration:none"><span dir="RTL" lang="AR-SA" style="font-size:14pt"><span style="font-family:"B Nazanin""></span></span></span></span></span></span></span></span></span><span style="font-size:12pt"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="FA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">سابقه</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt"> و هدف:</span></span></span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">خونریزی گوارشی فوقانی یکی از علل شایع مراجعه بیماران به اورژانس</span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar="">&rlm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">ها می</span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar="">&rlm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">باشد. در اکثر این بیماران خونریزی خود به خود متوقف می‌شود ولی تعدادی از بیماران </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">high risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> می</span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar="">&rlm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">باشند که ممکن است دچار عوارض متعددی شوند و افتراق آن</span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar="">&rlm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">ها از بیماران </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">low risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> در بخش</span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar="">&rlm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">های اورژانس از اهمیت ویژه‌ای برخوردار است. پرسشنامه</span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar="">&rlm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">های </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">Glasgow Blatchford Score</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">، </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">Clinical Rocall Score</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">Full Rocall Score</span></span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""> از رایج‌ترین پرسشنامه</span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar="">&rlm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">های بالینی برای ارزیابی بیماران مراجعه‌کننده با خونریزی گوارشی فوقانی می‌باشد.</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:#0e101a"></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">مواد و روش</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.1pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.1pt">ها:</span></span></span></span> <span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black">در این مطالعه توصیفی آینده‌نگر</span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""> برای ۲۴۹ بیمار با خونریزی گوارشی فوقانی مراجعه‌کننده به اورژانس</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">،</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""> پرسشنامه‌های </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">GBS</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">CRS</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> در بدو مراجعه</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""> و بعد از انجام آندوسکوپی</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">، </span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar="">پرسشنامه </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">FRS</span></span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""> کامل شد. سپس دو هفته بعد از ترخیص، </span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">چک لیستی شامل وضعیت</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""> مرگ و میر، خونریزی مجدد، نیاز بیماران به اقدامات جراحی وترانسفوزیون خون برای تعیین پروگنوز تکمیل شد.</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">یافته</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt">‌</span></span></span></span><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">ها:</span></span></span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">درسیستم امتیازدهی </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times=""><span style="letter-spacing:-.1pt">GBS</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt"> ۲۳۸ نفر (95/6درصد) </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times=""><span style="letter-spacing:-.1pt">high risk</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt"> محسوب می</span></span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">&rlm;</span></span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="letter-spacing:-.1pt">شدند و ۱۱ نفر (4/4درصد) </span></span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times=""><span style="letter-spacing:-.1pt">low risk</span></span></span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">بودند. درسیستم امتیازدهی </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">CRS</span></span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""> ۱۶۵ بیمار (66/3 درصد) </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">high risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> و ۸۴ بیمار (33/7درصد) </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">low risk</span></span></span><span style="line-height:90%"><span b="" style="font-family:" zar=""> بودند و در سیستم امتیازدهی </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">FRS</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> ۱۹۳ بیمار (77/5درصد) </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">high risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> محسوب می‌شدند و ۵۶ نفر (22/5درصد) </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">low risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> بودند.</span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:90%"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="line-height:90%"><span b="" koodak="" style="font-family:"><span style="color:black"><span style="letter-spacing:-.2pt">استنتاج:</span></span></span></span> <span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">سیستم امتیازدهی </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">FRS</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> معیاری قابل قبول برای شناسایی بیماران </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">high risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> و یک روش امتیازدهی بعد از آندوسکوپیک دقیق، برای شناسایی بیماران با پیش‌آگهی بد می‌باشد. در بین روش</span></span><span lang="FA" style="background:white"><span style="line-height:90%"><span b="" style="font-family:" zar="">&rlm;</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar="">های امتیازدهی قبل آندوسکوپیک </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">CRS</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> در شناسایی بیماران </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">low risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> ارزشمند می‌باشد و برای یافتن بیماران </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">low risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> و پیگیری و آندوسکوپی آن‌ها به‌صورت سرپایی ارزش بیش‌تری دارد و </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">GBS</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> در شناسایی بیماران </span></span><span dir="LTR" style="font-size:10.0pt"><span style="line-height:90%"><span style="font-family:" times="">high risk</span></span></span><span lang="FA" style="line-height:90%"><span b="" style="font-family:" zar=""> ارزشمندتر می‌باشد.</span></span><span lang="AR-SA" style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"><span style="letter-spacing:-.2pt"></span></span></span></span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:90%"><span style="tab-stops:284.5pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><span lang="AR-SA" style="font-size:8.0pt"><span style="line-height:90%"><span b="" style="font-family:" zar=""><span style="color:black"></span></span></span></span></span></span></span></span></span></span><br> <br> <span style="font-size:medium"><span new="" roman="" style="font-family:" times=""><span style="color:#000000"><span style="font-style:normal"><span style="font-weight:normal"><span style="white-space:normal"><span style="text-decoration:none"><span style="line-height:32px"><span style="direction:rtl"><span style="unicode-bidi:embed"><b><span lang="AR-SA" style="font-size:14pt"><span style="line-height:37.33333206176758px"><span b="" nazanin="" style="font-family:">&nbsp;</span></span></span></b></span></span></span></span></span></span></span></span></span></span> <span style="font-size:medium"><span new="" roman="" style="font-family:" times=""><span style="color:#000000"><span style="font-style:normal"><span style="font-weight:normal"><span style="white-space:normal"><span style="text-decoration:none"><span style="line-height:32px"><span lang="EN-US" style="line-height:32px">&nbsp;</span></span></span></span></span></span></span></span></span><span style="font-size:12pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span arial="" style="font-family:"><span style="letter-spacing:-.2pt">Background and purpose:</span></span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:150%">Upper gastrointestinal (GI) bleeding is one of the most common reasons for emergency admission. In majority of patients, bleeding stops spontaneously, but some high-risk patients may suffer from many complications secondary to upper GI bleeding, so differentiation of low-risk and high-risk patients in emergency departments is of particular importance. Glasgow Blatchford Score (GBS), Clinical Rockall Score (CRS) and Full Rockall Score (FRC) are the most common assessment tools for evaluating patients with upper GI bleeding.</span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:kashida"><span style="text-kashida:0%"><span style="line-height:150%"><span style="text-autospace:none"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span arial="" style="font-family:">Materials and methods:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:150%">In a prospective descriptive study, for 249 patients with upper GI bleeding who referred to an emergency department, GBS and CRS were used at first visit, and after endoscopy the FRC was used. Two weeks after discharge, a checklist was completed to determine the disease prognosis that included items about mortality, re-bleeding, the need for surgery, and blood transfusion.</span></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:150%"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span arial="" style="font-family:">Results:</span></span></span></b><b> </b><span style="font-size:10.0pt"><span style="line-height:150%">In Glasgow Blatchford Scoring system, 238 (95.6%) people were considered high risk and 11 (4.4%) patients were low risk. CRS showed 165 (66.3%) high-risk patients and 84 (33.7%) low-risk patients. According to FRC, 193 (77.5%) patients were high risk and 56 (22.5%) were low risk.</span></span></span></span></span><br> <span style="font-size:12pt"><span style="line-height:150%"><span style="vertical-align:top"><span new="" roman="" style="font-family:" times=""><b><span style="font-size:10.0pt"><span style="line-height:150%"><span arial="" style="font-family:">Conclusion:</span></span></span></b> <span style="font-size:10.0pt"><span style="line-height:150%">The Full Rockall scoring system is an acceptable criterion for identifying high-risk patients and a very accurate post-endoscopic scoring tool that helps in identifying patients with a poor prognosis. Among the pre-endoscopic scoring systems, CRS is valuable in identifying low-risk patients, and their follow-up and endoscopy as an outpatient procedure. GBS is more valuable in identifying high risk patients. </span></span></span></span></span></span><br> &nbsp; خونریزی گوارشی فوقانی حاد, گلسگو- بلچفورد اسکور, روکال اسکور بالینی, روکال اسکور کامل acute upper GI bleeding, Glasgow Blatchford Score, Clinical Rocall Score, Full Rockall Score 88 97 http://jmums.mazums.ac.ir/browse.php?a_code=A-10-1676-6&slc_lang=fa&sid=1 Seyed Mohammad Valizadeh Toosi سیدمحمد ولیزاده طوسی seyedmohammadv@yahoo.com 1003194753284600156082 1003194753284600156082 Yes Assistant Professor, Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran استادیار، گروه داخلی، مرکز تحقیقات گوارش و کبد، پژوهشکده بیماری‌های غیر واگیر، دانشگاه علوم پزشکی مازندران، ساری، ایران Iraj Maleki ایرج ملکی iradj2001@yahoo.com 1003194753284600156083 1003194753284600156083 No Associate Professor, Department of Internal Medicine, Gut and Liver Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran دانشیار، گروه داخلی، مرکز تحقیقات گوارش و کبد، پژوهشکده بیماری‌های غیر واگیر، دانشگاه علوم پزشکی مازندران، ساری، ایران Sanaz Gonoodi ساناز گنودی 1003194753284600156084 1003194753284600156084 No GI Fellowship, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran فلو فوق تخصصی گوارش، دانشکده پزشکی، دانشگاه علوم پزشکی مازندران، ساری، ایران