探讨影响食管静脉曲张破裂出血内镜疗法预后的相关因素  

Relative factors associated with the prognosis after endoscopic therapy in patients with esophageal varices bleeding

作　　者：王敏[1,2] 孔德润[3] 

机构地区：[1]安徽医科大学,安徽合肥230032 [2]铜陵职业技术学院,安徽铜陵244000 [3]安徽医科大学第一附属医院,安徽合肥230022

出　　处：《安徽医药》2013年第1期48-51,共4页Anhui Medical and Pharmaceutical Journal

基　　金：安徽省教育厅自然科学重点项目(No KJ2010A158);安徽省卫生厅医学科研课题(No 2010B018)

摘　　要：目的探讨内镜下食管曲张静脉套扎(Endoscopic Variceal Ligation,EVL)和硬化剂注射(Endoscopic Injection Sclerothera-py,EIS)治疗后影响食管静脉曲张破裂出血患者预后的相关因素。方法选取95例肝硬化食管静脉曲张破裂出血患者,所有患者均在接受内镜下套扎或硬化剂注射治疗后随访2年,根据2年内疾病转归将病例分为2组,死亡组24例,存活组71例。收集所有患者一般资料及临床影像学、生化指标,采用单因素分析法评估性别、年龄、生化指标、影像学检查、实验室检查等因素在2组间的差异性,并进一步采用多因素Logistic回归分析法评估内镜治疗后与患者预后相关的危险因素。结果单因素分析表明,2组患者在年龄、肝功能分级、出血程度、腹水程度、术后感染、凝血酶原时间、白蛋白水平、治疗方法、早期再出血情况等方面存在显著性差异(P<0.05)。多因素Logistic回归分析表明,术后感染(OR=2.938,P=0.045)、白蛋白(OR=0.887,P=0.019)、早期再出血(OR=4.268,P=0.015)在2组间差异显著。结论术后感染、白蛋白、早期再出血是影响内镜治疗后与患者预后的独立相关因素,其中术后感染和早期再出血为危险因素,白蛋白为保护因素。Objective Aim To explore the relative factors associated with the prognosis after endoscopic variceal ligation（EVL）or endoscopic injection sclerotherapy（EIS）in patients with esophageal varices bleeding（EVB）. Methods A total of 95 cirrhotic patients with esophageal varices bleeding,who all had the endoscopic therapies（EVL or EIS）and a 2-year follow-up since the time of the first endoscopic therapy.According to the prognosis of patients after 2-year follow-up,patients were divided into 2 groups,the death group（n=24）and the survival group（n=71）.The basal conditions of all the patients were collected to evaluate the difference between the 2 groups,such as basal datas,clinic materials of iconography and blood test.The difference in gender,age,blood test,iconography between the 2 groups were analyzed by single-variate logistic regression analysis respectively,and we also evaluated the risk factors associated with the prognosis of patients after endoscopic therapy by multivariate logistic regression analysis respectively.Results According to the result of single-factor logistic regression analysis,we found that there was a significant difference in age,the grade of liver function,the extent of hemorrhage,ascites levels,postoperative infection,prothrombin time,albumin,treatment methods and early re-bleeding between two groups after endoscopic treatment（P0.05）.Multivariate logistic regression analysis showed that there was a significant difference in postoperative infection（OR=2.938,P=0.045）,albumin（OR=0.887,P=0.019） and early re-bleeding（OR=4.268,P=0.015）between the two groups.Conclusions Postoperative infection,albumin and early re-bleeding are the independent relative factors of the patients with esophageal varices bleeding after endoscopic therapy.Postoperative infection and early re-bleeding are the risk factors and albumin is the protective factor.

关 键 词：食管静脉曲张 出血 套扎 硬化剂 预后 危险因素 

分 类 号：R575.2[医药卫生—消化系统]