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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。
Objective To apply the decision tree method to choose the best diagnosis and treatment plan for one case of emergency upper gastrointestinal bleeding. Methods According to the time and the logical sequence of clinical events, six steps of establishing decision-making problems, drawing the decision tree graph, identifying the probability of each outcome, assigning the final outcome with appropriate utility value, calculating and determining the best strategy, etc. Decision tree, find the best treatment plan for the case. The results of upper gastrointestinal bleeding in patients with ultra-early (6 hours) endoscopic treatment of prognosis is not significant. Patients who failed endoscopic treatment had lower mortality than those who underwent direct surgery with interventional therapy. Conclusion The clinical decision analysis by drawing a decision tree can help doctors to clarify the thinking, comprehensive and clear view of the clinical problems, and ultimately for the patient to choose the best course of treatment.