决策树在一例急诊上消化道出血患者诊疗方案制定中的应用.pdfVIP

实  践  与  交  流 2011, 11(5): 591 593 中国循证医学杂志 ～ 决策树在一例急诊上消化道出血患者 诊疗方案制定中的应用 王丽娜  潘曙明* 上海交通大学医学院附属新华医院急救中心（上海 200092 ） 摘要  目的 应用决策树方法为 1 例急诊上消化道出血患者选择最佳诊治方案。方法 按照临床事件发生的 时间和逻辑顺序，经过明确决策问题、绘出决策树图形、明确各结局出现概率、对最终结局用适宜的效用值赋值、 计算并确定最佳策略等6 个步骤构建完整的决策树，从中找到该病例的最佳诊疗方案。结果 上消化道出血患者 是否在超早期（6 小时内）行内镜治疗对预后影响不大。内镜治疗失败的患者采用介入治疗较直接手术探查死亡率 低。结论 通过绘制决策树进行临床决策分析，能帮助医生理清思路，全面而清晰地看待临床问题，并最终为患 者选择一条最佳治疗路线。 关键词 上消化道出血；临床决策分析；决策树 Use of Decision Tree in Treating an Emergency Patient with Upper Gastrointestinal Hemorrhage WANG Li-na, PAN Shu-ming* Emergency Center, Xin Hua Hospital Affiliated to School of Medicine of Shanghai Jiao Tong University, Shanghai 200092, China Abstract Objective To apply the method of evidence-based medicine to identify the best therapy option for an emergency patient with upper gastrointestinal hemorrhage. Methods According to time and logical sequence of clini- cal events, a complete decision tree was built after the following steps to find the best treatment: clear decision-making, drawing decision tree graphics, listing the outcome probability, giving appropriate values to the final outcome, calculating and determining the best strategies. Results The performance of endoscopic therapy for the patient with upper gastro- intestinal hemorrhage within the first six hours had little effect on the prognosis. Interventional therapy after the failure of endoscopic therapy had less mortality than direct surgical exploration. Conclusion Making clinical decision analyses via drawing the decision tree can help doctors clarify their ideas, get comprehensive views of clinical problems, and ultimately choose the best treatment strategy for patients. Key words Upper gastrointestinal hemorrhage; Clinical decision analysis; Decision tree 决策树作为决策分析的基本分析工具，是一种 其他慢性疾病史，本次发病前亦无进食坚硬食物或 按时间和逻辑顺序解决临床问题的方法。