肝硬化食管胃静脉曲张破裂出血患者内镜治疗后再出血的影响因素分析  

Analysis of influencing factors of rebleeding after endoscopic treatment in patients with esophageal and gastric variceal bleeding in liver cirrhosis

作　　者：李龙辉 王宇 高文广 高明 赵艳红 Li Longhui;Wang Yu;Gao Wenguang(Department of Gastroenterology,Fourth People's Hospital of Langfang,Langfang 065799,China)

机构地区：[1]廊坊市第四人民医院消化科,065799 [2]廊坊市第四人民医院心内科,065799 [3]廊坊市第四人民医院肿瘤科,065799 [4]廊坊市第四人民医院普内科,065799 [5]廊坊市第四人民医院护理科,065799

出　　处：《中华保健医学杂志》2022年第5期399-401,共3页Chinese Journal of Health Care and Medicine

基　　金：廊坊市科技技术局科研项目(2020013058)。

摘　　要：目的分析肝硬化门静脉高压食管胃静脉曲张破裂出血(esophagogastric variceal bleeding,EVB)患者经内镜治疗出血控制后12个月内出现活动性出血的影响因素。方法选取2015年2月~2020年12月因肝硬化胃食管静脉曲张破裂出血于廊坊市第四人民医院就诊的206例患者。根据内镜治疗后是否再次发生EVB分为出血组及未出血组。对两组的一般资料、实验室检查、超声及内镜检查及内镜手术方法进行单因素组间比较,将单因素组间比较有差异的因素纳入到非条件logistic回归,进行多因素logistic回归分析。结果出血组77例,未出血组129例,1年内再出血率为37.38%。两组间比较,Child-Pugh分级、腹水程度、AST、ALT、PLT、PT、门静脉内径、脾静脉内径及内镜下活动性出血组间差异有统计学意义(P<0.05)。多因素logistic回归分析显示,门静脉内径、PLT、PT、CTP分级、腹水程度是影响EVB患者发生再出血的独立危险因素。结论再出血受多种因素影响,需根据门静脉宽度、PLT、PT、腹水程度、CTP分级等风险因素对患者进行危险分层,及早对高危患者采取干预措施,降低患者再出血率,提高生存率。Objective To analyze the influencing factors of active bleeding within 12 months after endoscopic treatment and bleeding control in patients with esophagogastric variceal bleeding(EVB)with cirrhosis and portal hypertension.Method 206 patients with gastroesophageal variceal bleeding due to liver cirrhosis in our hospital from February 2015 to December 2020 were selected for analysis.EVB was divided into bleeding group and non bleeding group according to whether EVB occurred again after endoscopic treatment.The general data,laboratory examination,ultrasonography,endoscopy and endoscopic surgery methods of the two groups were compared between the single factor groups.The factors with differences between the single factor groups were included in the unconditional logistic regression for multivariate logistic regression analysis.Results There were 77 cases in the bleeding group and 129 cases in the non bleeding group.The rebleeding rate within one year was 37.38%.There were significant differences in child Pugh grade,ascites degree,AST,ALT,PLT,PT,portal vein diameter,splenic vein diameter and endoscopic active bleeding between the two groups(P<0.05).Multivariate logistic regression analysis showed that portal vein diameter,PLT,PT,CTP grade and ascites degree were independent risk factors for rebleeding in EVB patients.Conclusion Rebleeding is affected by many factors.It is necessary to classify the patients according to the risk factors such as portal vein width,PLT,PT,ascites degree and CTP grade,and take intervention measures for high-risk patients as soon as possible to reduce the rebleeding rate and improve the survival rate.

关 键 词：食管胃静脉曲张破裂出血 内镜静脉套扎术 硬化剂注射 再出血 门静脉内径 

分 类 号：R575[医药卫生—消化系统]