肝硬化患者上消化道出血危险因素与预后影响因素分析  

Risk factors and prognostic factors of gastrointestinal bleeding in patients with liver cirrhosis

作　　者：陈志敏[1] 仇建成 上官惠敏 王敬学[1] 张喜财[1] 

机构地区：[1]浙江省平阳县人民医院外科,浙江平阳县325400

出　　处：《中华医院感染学杂志》2015年第19期4488-4490,共3页Chinese Journal of Nosocomiology

基　　金：浙江省卫生厅基金资助项目(2013KYA121)

摘　　要：目的：探讨肝硬化合并上消化道出血的危险因素，分析出血患者影响预后的相关因素，为临床治疗提供参考。方法选取2008年6月－2014年8月566例肝硬化患者按照是否合并出血分为出血组320例和未出血组246例，分析两组患者凝血功能、幽门螺杆菌感染、肝功能评分等指标得出危险因素；将出血组再分为死亡组48例和生存组272例，对比两组患者出血次数、合并症等指标，研究影响预后的相关因素。结果单因素、多因素分析表明，胃左静脉内径、食管静脉曲张、腹水、P T＞16 s是上消化道出血的危险因素；肝硬化并上消化道出血预后独立危险因素为失血性休克（OR＝3．652，95％ C I＝1．12～3．13，P＝0．022）、胃底静脉曲张破裂（OR＝7．744，95％ CI＝4．43～11．53，P＝0．008）、合并症（OR＝4．872，95％ CI＝2．64～7．57，P＝0．010）。结论胃左静脉内径、腹水、食管胃静脉曲张、P T ＞16 s是上消化道出血的危险因素；出血量、反复出血、合并肝性疾病、肝功能Child C级均是预后的影响因素。OBJECTIVE To explore the risk factors of gastrointestinal bleeding in patients with liver cirrhosis and to investigate related factors affecting the prognosis of patients ,so as to provide a reference for clinical treatment . METHODS Totally 566 cases of patients with cirrhosis were selected from Jun .2008 to Aug .2014 .They were di‐vided into bleeding group with 320 cases and non‐bleeding group with 246 cases according to whether hemorrhage happened .Indicators like coagulation function ,Helicobacter pylori infection ,and liver function scores and so on were analyzed to derive risk factors ;the bleeding group was subdivided into death group with 48 cases and survival group with 272 cases .The bleeding times ,complications and other indicators were compared to get related factors affecting prognosis .RESULTS Single factor and multi factor analysis showed that left gastric vein diameter （OR=1 .527 ,95% CI=1 .02～2 .29 ,P=0 .038） ,esophageal varices （OR=8 .976 ,95% CI=5 .01～15 .97 ,P=0 .008 ） ,ascites （OR=4 .495 ,95% CI=2 .69～7 .53 ,P=0 .011） ,PT＆gt;16 s （OR=3 .011 ,95% CI=1 .49～3 .04 ,P=0 .023） were risk factors for upper gastrointestinal bleeding ;hemorrhagic shock（OR=3 .652 ,95% CI=1 .12～3 .13 ,P=0 .022） ,fundus of stomach varices bleeding（OR=7 .744 ,95% CI=4 .43～11 .53 ,P=0 .008） ,complica‐tions（OR=4 .872 ,95% CI=2 .64～7 .57 ,P=0 .010） were prognostic factors .CONCLUSION Left gastric vein di‐ameter ,ascites ,esophageal varices ,PT＆gt;16 s are the risk factors of upper gastrointestinal bleeding ;mass bleed‐ing ,recurrent bleeding ,hepatic disease ,liver function Child C grade were prognostic factors .

关 键 词：肝硬化 上消化道出血 危险因素 

分 类 号：R181.32[医药卫生—流行病学]