早期限制性液体复苏联合无痛胃镜治疗肝硬化上消化道大出血临床分析  

Application of early restrictive fluid resuscitation combined with painless gastroscope in the treatment of massive upper gastrointestinal bleeding in liver cirrhotic patients

作　　者：王晓梅[1] 赵蕊[1] 吴云海[1] 张明香[1] 张丽瑶[1] 孙丽[2] 牟峰[2] 

机构地区：[1]沈阳市第六人民医院肝病科,110006 [2]沈阳市第六人民医院麻醉科,110006

出　　处：《传染病信息》2015年第5期297-300,共4页Infectious Disease Information

基　　金：国家"十二五"科技重大专项(2012ZX10005004-001)

摘　　要：目的总结肝硬化食道胃底静脉曲张破裂大出血并失血性休克患者的抢救治疗和预后情况。方法回顾性分析我院2013年4月—2014年4月收入ICU的肝硬化食道胃底静脉曲张破裂大出血并失血性休克患者56例,采取多学科协作,在ICU床旁通过监测中心静脉压、平均动脉压和动脉血乳酸等指标进行早期限制性液体复苏联合急诊无痛胃镜下止血治疗,治疗后随访6个月。结果 54例(96.4%)止血成功,2例(3.6%)止血后24 h内再次大量出血,液体复苏未成功至临床死亡。存活54例3个月随访时有5例(9.3%)再出血,3例行二次胃镜下止血治疗,均为新发部位,2例药物止血治疗稳定后行经颈静脉肝内门体分流术治疗。6个月随访时另有3例(5.6%)再发出血,行二次胃镜下止血治疗,均为新发部位出血。结论肝硬化食道胃底静脉曲张破裂大出血并失血性休克患者在普通病房以传统单一药物治疗效果欠佳,须在ICU监护,采取限制性液体复苏,同时联合急诊无痛胃镜下止血治疗,效果显著,复苏成功率高,确保了患者镜下治疗的有效性及可实施性,是急诊抢救这类患者的可选手段之一。Objective To summarize and evaluate the surgical therapy and prognosis of massive esophageal and gastric varices bleeding and hemorrhagic shock in cirrhotic patients. Methods A total of 56 cirrhotic patients with esophageal and gastric varices bleeding and hemorrhagic shock admitted in intensive care unit（ICU） from April 2013 to April 2014 were retrospectively analyzed. A multi-disciplinary treatment was conducted by performing surgical interventions of early restrictive fluid resuscitation combined with painless gastroscope, while monitoring the indicators such as the central venous pressure, mean arterial pressure and blood lactic acid during the surgery at the bedside in ICU. All the patients were followed-up for 6 months after surgery. Results Bleeding was successfully controlled in 54 patients（96.4%）. Two patients（3.6%） had recurrent massive bleeding during 24 hours after surgery, failed in fluid resuscitation, and died. Of 54 survivors, 5 patients（9.3%） had recurrent bleeding at 3-month follow-up, of whom 3 patients received treatment to control bleeding by gastroscope, and 2 patients were treated by transjugular intrahepatic porto-systemic shunt after receiving medication. At 6-month follow-up, another 3 patients（5.6%） had recurrent bleeding in new focus and underwent a secondary treatment to control bleeding by gastroscope. Conclusions Cirrhotic patients with esophageal and gastric varices bleeding and hemorrhagic shock will have a poor prognosis if they are admitted in general wards and treated by conventional medication of single drug. Therefore, the patients need the intervention of restrictive fluid resuscitation in ICU ward combined with surgical therapy of painless gastroscope to control massive bleeding in time. As an option for the emergent treatment of this kind of patients, these procedures achieve good efficacy and high success rate of resuscitation, thus ensuring the effectiveness and feasibility of gastroscopic treatment.

关 键 词：肝硬化 胃肠出血 胃镜 

分 类 号：R575.2[医药卫生—消化系统]