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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
Risk factors for early rebleeding after esophageal variceal ligation in patients with liver cirrhosis
文章发布日期:2017年10月11日  来源:  作者:金燕,王雪,张玲娟,等  点击次数:138次  下载次数:26次

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【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=1.134)、套扎次数(t=3.902)等方面比较差异均有统计学意义(P值均<005)。多因素logistic回归分析结果显示,男性[比值比(OR)=1.598,95可信区间(95%CI):1.038~2.929],Child-Pugh评分>7.2(OR=2.306,95%CI:1.443~3.031),治疗前呕血:少量(OR=1.342,95%CI:1.014~2.627)、中量(OR=2.763,95%CI:1.356~4.122)、大量(OR=4.675,95%CI:2.321~6.929)等为EVL术后早期再出血的独立危险因素(P值均<0.05);Alb>31.5 g/L是EVL术后早期再出血的保护因素(OR=0.411,95%CI:0.288~0.641,P<0.05)。结论EVL术后应加强对男性患者的健康教育,早期纠正肝功能、凝血功能异常,改善患者Alb水平,防治腹水,提高扎套术实施技术水平,以降低EVL术后早期再出血的发生率。
【Abstract】:ObjectiveTo investigate the risk factors for early rebleeding after esophageal variceal ligation (EVL) in patients with liver cirrhosis. MethodsA 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. ResultsThe 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). ConclusionHealth 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.
【关键字】:肝硬化; 食管和胃静脉曲张; 失血,手术; 危险因素
【Key words】:liver cirrhosis; esophageal and gastric varices; blood loss, surgical; risk factors
【引证本文】:金燕,王雪,张玲娟,等. 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[J]. 临床肝胆病杂志, 2017, 33(11): 2147-2151.

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