急性食管胃底静脉曲张出血的控制及预后因素分析  

The control and prognostic factors analysis of acute gastroesophageal variceal hemorrhage

作　　者：王敏[1] 张倩倩[1] 许建明[1] 

机构地区：[1]安徽医科大学第一附属医院消化科,合肥230022

出　　处：《中华消化杂志》2012年第8期519-522,共4页Chinese Journal of Digestion

基　　金：国家自然科学基金（81070337）

摘　　要：目的分析控制急性食管胃底静脉曲张出血时间、治疗措施与预后的关系，探讨治疗失败的预测因素。方法收集309例急性食管胃底静脉曲张出血住院治疗者，回顾分析治疗后2h及2h以内、超过2h但不超过6h、超过6h但不超过5d、5d及5d以后的出血控制情况，分析控制出血时间与病死率之间的关系。比较单纯药物治疗者及药物治疗联合内镜治疗者控制出血成功率及病死率的差异。Logistic回归分析治疗失败的预测因素。结果在309例急性食管胃底静脉曲张出血患者中，2h及2h以内、超过2h但不超过6h、超过6h但不超过5d时间段内控制出血失败者分别有79、25、26例，死亡者分别有1、4、16例。药物治疗控制出血成功率为57．93％（179／309），病死率为10．36％（32／309）。药物治疗联合内镜治疗控制出血成功率为82．35％（28／34），病死率为0。Logistic回归分析显示，入院时收缩压≤90mmHg（1mmHg=0．133kPa）、总胆红素水平增高、肝功能Child—Pugh分级上升、有腹水是治疗失败的预测因素。结论控制出血失败时间多在2h及2h以内，随时间延长，病死率上升。药物治疗联合内镜治疗控制出血成功率较高，病死率较低。入院时收缩压≤90mmHg、总胆红素水平增高、肝功能Child—Pugh分级上升、有腹水可能是治疗失败的预测因素。Objective To analyze the correlation between the bleeding control time, treatment and prognosis in acute gastroesophageal variceal hemorrhage and to explore the predictive factors in treatment failure. Methods The clinical data of 309 patients with acute gastroesophageal variceal hemorrhage was collected. The bleeding control was retrospectively analyzed within and at two hours after treatment, over two hours but less than six hours, over six hours but less than five days, at and after five days. The correlation between bleeding control time and mortality rate was analyzed. The differences in success rate of bleeding control and mortality rate between medication treatment alone and medication combined with endoscopic treatment were compared. Logistic regression mode was used to analyze the predictive factors of treatment failure. Results Of the 309 acute gastroesophageal variceal hemorrhage hospitalized patients, the failure of bleeding control within and at two hours, over two hours but less than six hours and over six hours but less than five days were 79 cases, 25 cases and 26 cases respectively and there were one, four and 16 cases who died respectively. The success rate of bleeding control by medication treatment alone was 57.93 % （179/309） and the mortality was 10.36% （32/309）. The success rate of bleeding control by medication combined with treatment underendoscope was 82, 35 % （28/34） and the mortality rate was 0. The results of Logistic regression mode analysis indicated that the admission systolic blood pressure （490 mm Hg, 1 mm Hg=0. 133 kPa）, increase of total bilirubin, increase of Child-Pugh grade and ascites were the predictive factors of treatment failure. Conclusions The time of bleeding control failure mostly was within two hours. With time extended, the mortality increased. The success rate of bleeding control by medication combined with endoscopic treatment was higher and the mortality was lower. The admission systolic blood pressure lower than 90 mm Hg, increase of total bilir

关 键 词：食管和胃静脉曲张 胃肠出血 预后 内窥镜检查 

分 类 号：R575.2[医药卫生—消化系统]