肝硬化并食管胃静脉曲张二级预防胃镜复查必要性及依从性的临床研究  

Clinical study on the necessity and compliance of gastroscopy reexamination for secondary prevention in patients with cirrhosis complicated with esophageal and gastric varices

作　　者：佘倩 陈明锴[1] 肖勇[1] 张琎 刘小娇 邬海燕 Qian She;Ming-kai Chen;Yong Xiao;Jin Zhang;Xiao-jiao Liu;Hai-yan Wu(Department of Gastroenterology,Renmin Hospital of Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]武汉大学人民医院消化内科,湖北武汉430060

出　　处：《中国内镜杂志》2020年第7期13-19,共7页China Journal of Endoscopy

摘　　要：目的了解肝硬化并食管胃静脉曲张(EGV)二级预防胃镜复查的必要性及依从性。方法选取2017年1月-2019年6月于该院首诊并内镜证实为食管胃静脉曲张破裂出血(EGVB)的患者77例为观察组,肝硬化并EGV序贯治疗的患者69例为对照组,比较两组术前血液生化检查指标、是否入住重症监护室、是否输血、内镜治疗情况、术后5 d(再)出血率、在院死亡率、住院天数、住院期间并发症/合并症,了解二级预防胃镜复查及序贯治疗的必要性,并分析胃镜复查依从性的影响因素。结果观察组白细胞计数(WBC)、中性粒细胞计数百分比(Neu)、总胆红素(TBil)、血尿素氮(UREA)、凝血酶原时间(PT)、国际标准化比值(INR)、Child-Pugh分级(B级+C级)比例、终末期肝病模型(MELD)评分明显高于对照组(P<0.05),血红蛋白(Hb)、血细胞比容(HCT)、白蛋白(ALB)、纤维蛋白原(FIB)明显低于对照组(P<0.05)。观察组入住重症监护室需求、输血需求、急诊内镜下治疗需求、术后住院天数、总住院天数、在院期间并发症/合并症发生率明显多于对照组(P<0.05)。对照组随访期间胃镜复查依从性明显高于观察组(P<0.05)。有EGV序贯治疗史随访期间胃镜复查依从性更高(P<0.05),年龄、性别、肝硬化病因、住址、医保类型和既往EGVB次数不影响胃镜复查依从性。结论相较EGVB,EGV序贯治疗肝脏储备功能恶化不明显、并发症/合并症发生率更低、住院时间更短、花费更低,能减轻医疗负担。胃镜复查可指导内镜下序贯治疗,然而EGVB患者二级预防胃镜复查依从性并不高。加强患者宣教、提高随访期间胃镜复查必要性认识及胃镜复查依从性是临床医生工作的重点。Objective To learn about the necessity and compliance of gastroscopy reexamination for secondary prevention in patients with cirrhosis complicated with esophageal gastric varices(EGV).Methods From January 2017 to June 2019,77 patients with EGVB confirmed by endoscopy were selected as the observation group,69 patients with simultaneous segmental liver cirrhosis complicated with EGV sequential treatment were selected as control group.The indexes of preoperative blood test,whether they were admitted to intensive care unit,whether blood transfusion,endoscopic treatment,at 5 days postoperative bleeding rate,mortality in hospital,hospitalization days,complications/complications during hospitalization were compared between the two groups to understand the necessity of gastroscopic reexamination and sequential treatment during follow-up.Analysis of gastroscopy review compliance factors.Result The white blood cell count,percentage of neutrophils count,total bilirubin,blood urea nitrogen,PT,INR,Child-Pugh grade(grade B+C)and MELD score in the observation group were significantly higher than those in the control group(P<0.05),hemoglobin,hematocrit,albumin and fibrinogen were significantly lower than the control group(P<0.05).The needs of intensive care unit,blood transfusion,emergency endoscopic treatment and the postoperative hospitalization days,the total hospitalization days and the incidence of complications/complications in the observation group were significantly higher than those in the control group(P<0.05).The compliance of gastroscopy during the follow-up of the control group was significantly higher than that of the observation group(P<0.05),and the compliance of gastroscopy was higher during the follow-up of the EGV endoscopic sequential therapy(P<0.05).Age,gender,etiology of cirrhosis,address,type of medical insurance and previous number of EGVB did not affect the compliance of gastroscopy review.Conclusion Compared with EGVB attack,the deterioration of liver reserve function under EGV endoscopic sequential the

关 键 词：肝硬化 静脉曲张破裂出血 二级预防 胃镜检查 必要性 依从性 

分 类 号：R575.2[医药卫生—消化系统] R573[医药卫生—内科学]