限制性补液在肝硬化合并上消化道大出血治疗中的应用  

Application of limited fluid infusion to cirrhosis patients combined with massive upper gastrointestinal hemorrhage

作　　者：张成斌[1] 赵宏[2] 陈志敏[1] 孙娟[1] 

机构地区：[1]蚌埠医学院第二附属医院消化内科,安徽蚌埠233040 [2]蚌埠医学院第二附属医院神经内科,安徽蚌埠233040

出　　处：《蚌埠医学院学报》2014年第4期459-461,465,共4页Journal of Bengbu Medical College

摘　　要：目的:探讨限制性补液治疗肝硬化合并上消化道大出血的临床疗效。方法:将肝硬化合并上消化道大出血的109例患者,随机分为限制性补液组53例和对照组56例,分别给予限制性补液和常规补液及抑酸、止血、降门静脉压等治疗。观察2组止血时间、并发症发生情况及病死率差异。结果:限制性补液组止血时间明显少于对照组(P<0.01)。限制性补液组仅2例并发轻微肝性脑病,无一例病死;对照组3例并发肝性脑病,13例并发腹水,4例出现少尿或无尿,1例并发自发性腹膜炎,14例病死,2组患者并发症和病死率差异均有统计学意义(P<0.01)。结论:对于肝硬化合并上消化道大出血患者,限制性补液有利于止血,并且可以减少出血期腹水、肝性脑病、肝肾综合征等并发症的发生,最终降低病死率。Objective：To investigate the clinical effect of limited fluid infusion in treatment of cirrhosis patients with massive upper gastrointestinal hemorrhage. Methods ： One hundred and nine cirrhosis patients with massive upper gastrointestinal hemorrhage were randomly divided into limited fluid infusion group （53 cases ） and limited fluid infusion group （56 cases ）, and each group was given limited fluid infusion or common fluid infusion as well as therapies for restraining the gastric acid, hematisehesis and lowering the portal venous pressure. The hematischesis time, complication and mortality rate were compared between the two groups. Results：The average hemostasis time of limited fluid infusion group was obviously less than that of the control group （ P 〈 0. 01 ）. In limited fluid infusion group, only 2 patients presented mild hepatic encephalopathy and no one died;however, in the control group, 3 patients had hepatic encephalopathy, 13 were complicated with aseites,4 presented oliguria or anuria, 1 was complicated with spontaneous peritonitis and 14 died. The complication and fatality rates had statistical difference between the two groups （ P 〈 0.01 ）. Conclusions ： Limited fluid infusion is advantageous for cirrhosis patients combined with massive upper gastrointestinal hemorrhage. It may reduce the incidence of ascites, hepatic eneephalopathy and hepatorenal syndrome, eventually decreasing the fatality rate.

关 键 词：肝硬化 上消化道大出血 限制性补液 

分 类 号：R575.2[医药卫生—消化系统]