肝硬化上消化道出血危险因素及预后  

The Study of Risk Factors and Prognostic Factors of Cirrhotic Patients with Upper Gastrointestinal Bleeding

作　　者：冯静云[1] 陆士奇[2] 

机构地区：[1]常州市第三人民医院重症医学科,江苏常州213000 [2]苏州大学第一附属医院急诊科,江苏苏州215003

出　　处：《锦州医科大学学报》2017年第6期31-35,共5页Journal of Jinzhou Medical University

摘　　要：目的探讨肝硬化上消化道出血危险因素和预后因素。方法将2015年12月至2016年12月期间住院治疗的105例肝硬化患者纳入课题研究,按照是否出现上消化道出血现象分为出血组(42例)和非出血组(63例)。将42例出血组患者再根据预后情况分为生存组(23例)和死亡组(19例)。进行单因素和Logistic回归分析。结果上消化道出血病史、胃底静脉曲张、红色征、肝功能分级、门静脉内径、腹水、血清肌酐、凝血酶原时间、血红蛋白和血小板计数10个因素在两组间的差异有显著性(P<0.05);胃底静脉曲张、凝血酶原时间、腹水、门静脉内径是肝硬化患者上消化道出血的4个独立危险因素。上消化道出血病史、休克指数、肝性脑病、感染、肝功能分级、腹水、门静脉内径、血清肌酐、凝血酶原时间、血清胆红素、血红蛋白和血小板计数12个因素在两组间的差异有显著性(P<0.05);休克指数、血清胆红素、肝性脑病是对肝硬化上消化道出血患者的预后有显著性影响的3个独立危险因素。结论胃底静脉曲张、凝血酶原时间、腹水、门静脉内径是肝硬化患者上消化道出血的4个独立危险因素;休克指数、胆红素、肝性脑病是对肝硬化上消化道出血患者的预后有显著性影响的3个独立危险因素。Objective To explore the risk factors and prognostic factors of cirrhotic patients with upper gastrointestinal bleeding.Methods 105 patients with liver cirrhosis admitted in our hospital from December 2015 to December 2016 were selected and divided into bleeding group（ 42 cases） and non-bleeding group（ 63 cases） according to whether they had upper gastrointestinal bleeding. 42 cases of bleeding group were divided into survival group（ 23 cases） and death group（ 19 cases） according to their prognosis. Single factor analysis and logistic regression analysis were performed. Results There were significant differences between bleeding group and non-bleeding group in terms of history of upper gastrointestinal bleeding,gastric varices,red-color sign,child-pugh,portal venous diameter,ascites,serum creatinine,prothrombin time,hemoglobin and blood platelet count（ P〈0. 05）. 4 independent risk factors for cirrhotic patients with upper gastrointestinal bleeding included gastric varices,prothrombin time,ascites and portal venous diameter. There were statistically significant differences in history of upper gastrointestinal bleeding,shock index,splenectomy,infection,child-pugh,ascites,portal venous diameter,serum creatinine,prothrombin time,serum bilirubin,hemoglobin and blood platelet count between survival group and death group（ P〈0. 05）. Shock index,serum bilirubin and splenectomy were 3 independent prognostic factors for cirrhotic patients with upper gastrointestinal bleeding. Conclusion Gastric varices,prothrombin time,ascites and portal venous diameter were 4 independent risk factors for cirrhotic patients with upper gastrointestinal bleeding while shock index,serum bilirubin and splenectomy were 3 independent prognostic factors for prognosis.

关 键 词：肝硬化 上消化道出血 危险因素 预后因素 

分 类 号：R575.2[医药卫生—消化系统]