急性食管胃底静脉曲张破裂出血的控制及预后300例  

Management and prognosis of acute esophageal variceal bleeding: Analysis of 300cases

作　　者：蔡胤浩[1] 张亚华[1] 陈万伟[2] 罗莎莎[1] 何恩乐[1] 游明瑶[3] 

机构地区：[1]贵阳医学院附属医院急诊内科,贵州省贵阳市550004 [2]贵阳医学院附属医院消化内科,贵州省贵阳市550004 [3]贵阳医学院附属医院神经内科,贵州省贵阳市550004

出　　处：《世界华人消化杂志》2013年第30期3257-3260,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨急性食管胃底静脉曲张破裂出血(bleeding esophageal varice,BEV)的治疗方法、控制时间及预后之间的关系,找出预测控制出血无效的主要因素.方法:选取2008-01/2013-01入我院治疗的300例BEV患者,回顾分析治疗后≤2 h、>2 h但≤6 h、>6 h但≤5 d、≥5 d的出血控制状况,剖析控制出血时段与病死率的关系.将单纯药物与药物联合内镜两种治疗措施在控制出血有效率与病死率间的差异进行对比.Logistic回归分析预测治疗无效的因素.结果:300例BEV患者内,入院治疗时段出血控制无效者≤2 h、>2 h但≤6 h、>6 h但≤5 d时段内各自为75、25、27例,病死依序为1、3、16例.≤2 h时段出血未获控制病死率较高,≤2 h时段出血控制可降低病死率,支持>2 h出血未获控制须立即转换治疗的共识.药物治疗控制出血有效率为57.67%(173/300),病死率为9.67%(29/300).药物治疗控制出血无效后,组织黏合剂注射或套扎联合内镜治疗的控制出血有效率为90.00%(27/30),死亡率为0.Logistic回归显示,入院时收缩压≤90 mmHg、总胆红素表达加大、肝功能分级提升、有腹水为预测治疗无效的因素.结论:有腹水、总胆红素表达加大、入院时收缩压≤90 mmHg、肝功能Child-Pugh分级提升等状况也许为预测治疗无效的因素;控制出血无效时段多发于≤2 h,病死率随时间延长上升;>2 h出血未获控制须立即转换治疗;药物联合内镜治疗控制出血有效率较高,病死率较低.AIM： To analyze the treatment, management duration and prognosis of acute esophageal variceal bleeding and to identify predictive factors for treatment failure. METHODS： Clinical data for 300 patients with acute esophageal variceal bleeding treated at our hospital from January 2008 to January 2013 were analyzed retrospectively. Bleeding control was analyzed ≤ 2 h, 〉 2 h but ≤ 6 h, 〉 6 h but ≤ 5 d, or ≥ 5 d after treatment to find the relationship between bleeding control time and mortality. The effective rate and mortality were compared between patients treated with simple drugs and those treated with drugs combined with endoscopic therapy. Logistic regression analysis was used to identify predictive factors for treatment failure. RESULTS： The number of patients having ineffective bleeding management was 75, 25 and 27 in the ≤ 2 h, 〉2 h but ≤ 6 h, and 〉6 h but ≤ 5 d groups, respectively, and the number of dead patients was 1, 3 and 16, respectively. The percentage of patients having ineffective bleeding management was higher in the ≤ 2 h group. The effective rate of drug therapy in management of bleeding was 57.67% （173/300）, and the mortality was 9.67% （29/300）. The effective rate of tissue adhesive injection or ligation combined with endoscopic therapy in controlling bleeding in patients after ineffective drug therapy was 90.00% （27/30）, and the mortality was 0. Logistic regression analysis showed that admission systolic blood pressure ≤ 90 mmHg, increased total bilirubin, high liver function classification, and ascites were predictive factors for treatment failure. CONCLUSION： Ascites, increased total bilirubin, admission systolic blood pressure ≤ 90 mmHg, and high Child-Pugh classification can predict treatment failure in patients with acute esophageal variceal bleeding. Invalid bleeding control is more common during ≤ 2 h after treatment. Mortality increases with time. If bleeding can not be controlled effectively 2 h after treatment, treatment conversi

关 键 词：急性食管胃底静脉曲张破裂出血 胃肠出血 套扎术 组织黏合剂 垂体后叶素 奥曲肽 内镜检查 治疗方法 预后 预测因素 

分 类 号：R575.2[医药卫生—消化系统]