肝硬化胃食管静脉曲张破裂出血预后探讨  

The mortality and prognostic indicators of gastroesophageal variceal bleeding in cirrhosis

作　　者：朱龙川[1] 徐龙[1] 熊晓晴[1] 文卓夫[2] 

机构地区：[1]南昌市第九医院肝二科,南昌330002 [2]中山大学第三附属医院消化内科,广州510630

出　　处：《江西医药》2013年第4期288-292,共5页Jiangxi Medical Journal

摘　　要：目的探讨肝硬化胃食管静脉曲张破裂出血的预后。方法回顾性分析357例肝硬化胃食管静脉曲张破裂出血患者的病历资料,分析其病死率、死因、急诊止血方式等情况,先后通过单因素分析及多元Logistic回归分析来研究对死亡具有显著影响的独立预后指标。结果357患者中,轻度出血84例(23.5%),中度出血219例(61.3%),重度出血54例(15.2%)。药物组、内镜组、三腔二囊管组及联合组急诊止血效果差异无统计学意义(P>0.05)。全组总病死率11.5%。多元Logistic回归分析表明,门冬氨酸氨基转移酶、总胆红素、胃镜检查及出血程度是死亡的独立预后指标,其中胃镜检查是保护性因素。结论肝硬化胃食管静脉曲张破裂出血程度以中度为主,病死率较既往明显下降。不同急诊止血方式效果相当。早期的胃镜检查有助于改善预后。Objective To investigate the mortality and prognostic indicators of Gastroesophageal Variceal Bleeding(GEVB). Methods A review of 357 GEVB patients’ clinical records was carried out.Information including emergency hemostasis therapy, mortality,death causes and so on was collected.Candidate prognostic indicators were processed first by univariate analysis and then multiple logistic regression analysis.Results All the 357 cases were available.There were 84(23.5%) cases of mild,219(61.3%) cases of moderate,and 54(15.2%) cases of severe bleeding.Different ways of emergency hemostasis,including drug,endoscopy,sengstaken-blakemore tube and combined therapy,lead to similar hemostasis rate(P>0.05).The total mortality was 11. 5%.The multiple logistic regression analysis showed that AST,TB,endscopy diagnosis(protective factor) and severity of bleeding were prognostic indicators for GEVB death.Conclusion Moderate bleeding is main in severity.The mortality of GEVB has remarkably decreased compared with previous reports.Different ways of stopping bleeding lead to similar hemostasis effect.Early endscopy diagnosis may improve the prognosis.

关 键 词：肝硬化 胃静脉曲张 食管静脉曲张 出血 死亡 预后指标 

分 类 号：R9[医药卫生—药学]