肝硬化患者食管静脉曲张套扎术后早期再出血的危险因素分析

金燕; 王雪; 张玲娟; 邱婷; 商博鑫; 廉小延; 阎春英; 段天娇; 张蓉; 刘贵生

doi:10.3969/j.issn.1001-5256.2017.11.019

肝硬化患者食管静脉曲张套扎术后早期再出血的危险因素分析

DOI: 10.3969/j.issn.1001-5256.2017.11.019

陕西省人民医院消化内一科

详细信息

中图分类号: R575.2
计量
- 文章访问数: 2301
- HTML全文浏览量: 38
- PDF下载量: 432
- 被引次数: 0
出版历程
- 收稿日期: 2017-07-19
- 出版日期: 2017-11-20

Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis

First Department of Gastroenterology, Shaanxi Provincial People's Hospital

摘要

摘要: 目的探讨肝硬化食管静脉曲张套扎（EVL）术后早期再出血的相关危险因素。方法回顾性分析2000年1月-2016年5月收入陕西省人民医院的肝硬化食管静脉曲张并接受EVL治疗的506例患者资料,根据是否有术后早期出血分成出血组（n=38）和无出血组（n=468）。收集可能导致术后再出血的影响因素。符合正态分布的计量资料组间比较采用t检验;计数资料组间比较采用χ2检验;独立危险因素分析采用非条件多因素logistic回归分析。结果单因素分析结果显示,2组患者在性别（χ2=5.675）、治疗前呕血次数（t=1.335）、治疗前呕血量（χ2=1.983）、黑便次数（t=2.984）、静脉曲张条数（t=1.083）、血清PT（t=2.182）、PTA（t=2.584）、Alb（t=1.046）、TBil（t=2.463）、AST（t=3.473）、腹水严重程度（χ2=8.484）、Child-Pugh评分（t=1.664）、Child-Pugh分级（χ2=15.675）、套扎点数（t=1.1...
- 肝硬化 /
- 食管和胃静脉曲张 /
- 失血,手术 /
- 危险因素
Abstract: Objective To investigate the risk factors for early rebleeding after esophageal variceal ligation (EVL) in patients with liver cirrhosis.Methods A retrospective analysis was performed for the clinical data of 506 cirrhotic patients with esophageal varices who were admitted to Shaanxi Provincial People's Hospital from January 2000 to May 2016 and underwent EVL, and according to the presence or absence of early rebleeding after surgery, these patients were divided into bleeding group with 38 patients and non-bleeding group with 468 patients.The factors that could lead to postoperative rebleeding were collected.The t-test was used for comparison of normally distributed continuous data between groups, and the chi-square test was used for comparison of categorical data.An unconditional multivariate logistic regression analysis was used to investigate independent risk factors.Results The univariate analysis showed that there were significant differences between the two groups in sex (χ2=5.675) , number of times of hematemesis before treatment (t=1.335) , amount of hematemesis before treatment (χ2=1.983) , number of times of melena (t=2.984) , number of varicose veins (t=1.083) , serum prothrombin time (t=2.182) , prothrombin time activity (t=2.584) , albumin (Alb) (t=1.046) , total bilirubin (t=2.463) , aspartate transaminase (t=3.473) , severity of ascites (χ2=8.484) , Child-Pugh score (t=1.664) , Child-Pugh class (χ2=15.675) , number of ligation points (t=1.134) , and number of times of ligation (t=3.902) (all P<0.05) .The multivariate logistic regression analysis showed that male sex (odds ratio [OR]=1.598, 95% confidence interval [CI]:1.038-2.929) , Child-Pugh score>7.2 (OR=2.306, 95% CI:1.443-3.031) , and small, moderate, and large amounts of hematemesis before treatment (OR=1.342, 2.763, and 4.675, 95% CI:1.014-2.627, 1.356-4.122, and 2.321-6.929) were independent risk factors for early rebleeding after EVL (all P<0.05) , while Alb>31.5 g/L was a protective factor against early rebleeding after EVL (OR=0.411, 95% CI:0.288-0.641, P<0.05) .Conclusion Health education should be enhanced for male patients after EVL, and early correction of liver function and coagulation disorders, improvement of Alb level, prevention and treatment of ascites, and improvement in technical level of ligation may help to reduce the incidence rate of early rebleeding after EVL.
- liver cirrhosis /
- esophageal and gastric varices /
- blood loss, surgical /
- risk factors

HTML全文

参考文献(20)

[1]ZHENG MQ.Risk factors of early rebleeding after esophageal variceal ligation[D].Hangzhou:Zhengjiang Univ, 2009. (in Chinese) 张咩庆.食管静脉曲张套扎术后早期再出血的危险因素研究[D].杭州:浙江大学, 2009.

[2]ZHANG H, JIN J, ZUO F, et al.Observation on the efficacy of treating liver cirrhosis with esophageal varices bleeding using endoscopic ligation:56 cases[J].Shandong Med J, 2015, 55 (2) :63-65. (in Chinese) 张晖, 进军, 左凡, 等.内镜下食管静脉曲张套扎术治疗肝硬化食管静脉曲张56例疗效观察[J].山东医药, 2015, 55 (2) :63-65.

[3]LO GH, LAI KH, CHENG JL, et al.A prospective, randomized trial of sclerotherapy versus ligation in the management of bleeding esophageal varices[J].Hepatology, 1995, 22 (15) :466-471.

[4]Chinese Society of Digestive Endoscopy.Chinese Society of Digestive Endoscopy.Standard endoscopic diagnosis and treatment of esophageal and gastric varices (on trial) [J].Chin J Dig Endosc, 2000, 17 (4) :198-199. (in Chinese) 中华消化内镜学会.食管胃底静脉曲张内镜下诊断和治疗规范试行方案[J].中华消化内镜杂志, 2000, 17 (4) :198-199.

[5]SUN Y, REN TS, ZHAO QC.Analysis of drug use in 537 patients with decompensated liver cirrhosis[J].Trauma Crit Med, 2016, 4 (4) :229-235. (in Chinese) 孙滢, 任天舒, 赵庆春.肝硬化失代偿期537例患者用药分析[J].创伤与急危重病医学, 2016, 4 (4) :229-235.

[6]TSOKOS M, TURK EE.Esophageal variceal hemorrhage presenting as sudden death in outpatients[J].Arch Pathol Lab Med, 2002, 126 (12) :1197-1200.

[7]HU YW.Analysis of risk factors of rebleeding within one year after endoscopic treatment of liver cirrhosis and gastroesophageal variceal hemorrhage[D].Nanchang:Nanchang Univ, 2016. (in Chinese) 胡友文.肝硬化并食管胃静脉曲张出血内镜治疗术后1年内再出血风险因素分析[D].南昌:南昌大学, 2016.

[8]HEIKKINEN M, VSTRIK R, KARJALAINEN-LINDSBERG ML, et al.Esophageal varices and dyspnea.A clinicopathological conference report[J].Duodecim, 2014, 130 (7) :706-713.

[9]JALLI R, KAZEM HOSSEINI-ASL M, ESHRAGHIAN A, et al.Ultra-sound based techniques and transient elastography may not be precise methods for the detection of esophageal varices in liver cirrhosis[J].Med Ultrason, 2014, 16 (1) :78-79.

[10]ZHANG JP, JIANG LY, SHEN YJ.Endoscopic ligation of multiple serial of treatment of esophageal varices[J].J Changchun Univ Chin Med, 2016, 32 (4) :816-818. (in Chinese) 张金萍, 姜连英, 沈玉杰.内镜下多连环结扎术治疗食管静脉曲张的护理[J].长春中医药大学学报, 2016, 32 (4) :816-818.

[11]XU L, JI F, XU QW, ZHANG MQ, et al.Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation[J].World JGastroenterol, 2011, 17 (28) :3347-3352.

[12]AL-BUSAFI SA, GHALI P, WONG P, et al.Endoscopic management of portal hypertension[J].Int J Hepatol, 2012, 12 (14) :747-752.

[13]CHEN J, ZENG XQ, MA LL, et al.Randomized controlled trial comparing endoscopic ligation with or without sclerotherapy for secondary prophylaxis of varicealbleeding[J].Eur J Gastroenterol Hepatol, 2016, 28 (1) :95-100.

[14]KAPOOR A, DHAREL N, SANYAL AJ.Endoscopic diagnosis and therapy in gastroesophageal variceal bleeding[J].Gastrointest Endosc Clin N Am, 2015, 25 (3) :491-507.

[15]KUMAR S, ASRANI SK, KAMATH PS.Epidemiology, diagnosis and early patient management of esophagogastric hemorrhage[J].Gastroenterol Clin North Am, 2014, 43 (4) :765-782.

[16]DAI C, LIU WX, JIANG M, et al.Endoscopic variceal ligation compared with endoscopic injection sclerotherapy for treatment of esophageal variceal hemorrhage:a meta-analysis[J].World J Gastroenterol, 2015, 21 (8) :2534-2541.

[17]VUACHET D, CERVONI JP, VUITTON L, et al.Improved survival of cirrhotic patients with variceal bleeding over the decade 2000-2010[J].Clin Res Hepatol Gastroenterol, 2015, 39 (1) :59-67.

[18]de FRANCHIS R, BAVENO VI FACULTY.Expanding consensus in portal hypertension:report of the Baveno VI Consensus Workshop:stratifying risk and individualizing care for portal hypertension[J].J Hepatol, 2015, 63 (3) :743-752.

[19]MOSTAFA EF, MOHAMMAD AN.Incidence and predictors of rebleeding after band ligation of oesophageal varices[J].Arab J Gastroenterol, 2014, 15 (3-4) :135-141.

[20]TRIANTOS C, KALAFATELI M.Endoscopic treatment ofesophageal varices in patients with liver cirrhosis[J].World J Gastroenterol, 2014, 20 (36) :13015-13026.

施引文献

资源附件(0)

访问统计