组织胶联合聚桂醇急诊内镜下注射治疗食管胃底静脉曲张破裂后出血预后因素分析  

Analysis of prognostic factors in patients with esophageal and gastric varices bleeding after endoscopic injection of tissue adhesive combined with polidocanol

作　　者：刁云辉[1] 贺东黎[1] 戴兵[2] 王祟奇 

机构地区：[1]河南省南阳市中心医院消化内科1病区,河南南阳473009 [2]河南省南阳市中心医院普通外科肝脏病区,河南南阳473009

出　　处：《中国现代医学杂志》2017年第11期117-121,共5页China Journal of Modern Medicine

摘　　要：目的探讨组织胶联合聚桂醇急诊内镜下注射治疗食管胃底静脉曲张破裂后出血预后因素。方法回顾性分析132例食管胃底静脉曲张出血患者,统计患者再出血率,按照是否出血分为观察组和对照组,统计分析再出血的影响因素。结果观察组[国际标准化比率(INR)>1.5、门静脉右支直径(RVD)<8.5 mm]患者的百分率、终末期肝病模型(MELD)评分、4因子的纤维化指数(FIB4)评分、凝血酶原时间(PT)及总胆红素(TB)高于对照组(χ~2=6.693和21.827,P=0.028和0.000;t=7.217、32.041、11.674和7.554,P=0.026、0.000、0.000、0.000和0.026),而血钠、血白蛋白低于对照组(t=16.043和15.271,均P=0.000)。Logistic回归分析显示,INR>1.5、MELD评分、FIB4评分及PT为组织胶联合聚桂醇治疗后再出血的独立危险因素,而RVD>8.5 mm、血钠、血白蛋白是预后保护因素。结论肝功能进一步恶化以及凝血功能障碍可能是导致组织胶联合聚桂醇治疗食管胃底静脉曲张(GOV)再出血预后的影响因素。Objective To investigate the prognostic factors of esophageal gastric varices bleeding after endoscopic injection of tissue adhesive combined with polidocanol. Methods 132 cases with esophageal and gastric varices bleeding were retrospectively analyzed. The recurrent bleeding rate was statistically analyzed. According to bleeding or not, patients were divided into observation group and control group. The influencing factors were analyzed. Results The percentage of patients with INR 〉 1.5 and RVD 〈 8.5 ram, MELD score, FIB4 score, PT and TB were significantly higher in the observation group than those in the control group （χ2= 6.693 and 21.827, P=0.028 and 0.000; t=7.217, 32.041, 11.674 and 7.554, P=0.026, 0.000, 0.000, 0.000 and 0.026）, while serum sodium and serum albumin were significantly lower than those in control group （t = 16.043, 15.271, P=0.000）. Logistic regression analysis showed that INR 〉 1.5, MELD score, FIB4 score and PT were independent risk factors for rebleeding after treatment with tissue glue and polidocanol. RVD 〉 8.5 mm, serum sodium and serum albumin were prognostic factors. Conclusions Further deterioration of liver function and coagulation dysfunction may be the influencing factors in the treatment of patients with GOV.

关 键 词：食管胃底静脉曲张 组织胶 聚桂醇 再出血 预后 

分 类 号：R571.3[医药卫生—消化系统]