内镜联合药物治疗肝硬化食管胃底静脉曲张破裂出血的临床疗效及再出血危险因素分析  

Analysis of Clinical Efficacy and Risk Factors of Rebleeding of Esophageal and Gastric Varices Treated with Endoscopy Combined with Drugs in Cirrhotic Patients

作　　者：滕飞 陈志强 严亚辉 TENG Fei;CHEN Zhiqiang;YAN Yahui(Xinyang People’s Hospital,Xinyang,China,464000;Xinyang Central Hospital,Xinyang,China,464000)

机构地区：[1]信阳市人民医院,河南信阳464000 [2]信阳市中心医院,河南信阳464000

出　　处：《食管疾病》2024年第3期212-216,共5页Journal of Esophageal Diseases

摘　　要：目的研究肝硬化食管胃底静脉曲张破裂出血(esophagogastric variceal bleeding,EGVB)治疗过程中选用内镜联合药物方案的疗效及再出血危险因素。方法选取信阳市人民医院2021年1月30日至2023年1月30日收治的200例肝硬化EGVB患者,随机分为观察组及对照组各100例。对照组选用单纯药物治疗,观察组则开展内镜联合药物治疗。对比两组临床疗效,并以单因素、多因素Logistic回归分析明确肝硬化EGVB患者再出血的危险因素。结果观察组治疗总有效率高于对照组(92.00%VS 71.00%)(P<0.05)。再出血组内镜联合药物治疗人数占比低于无再出血组(31.25%VS 73.86%)(P<0.05);两组其他各项基线资料对比差异均无统计学意义(均P>0.05)。再出血组白蛋白、血钠水平分别为(24.31±3.87)g·L^(-1)、(126.02±10.71)mmol·L^(-1),均低于无再出血组的(31.50±4.56)g·L^(-1)、(138.02±12.45)mmol·L^(-1)(均P<0.05)。经多因素Logistic回归分析证实,肝硬化EGVB患者再出血的危险因素包括单纯药物治疗、白蛋白降低及血钠降低(OR=1.862、2.425、2.661,均P<0.001)。结论内镜联合药物治疗肝硬化EGVB的临床疗效较佳,单纯药物治疗以及低白蛋白、血钠水平患者再出血风险较高。Objective To study the efficacy and risk factors for rebleeding during the treatment of esophageal variceal bleeding(EGVB)in patients with liver cirrhosis using an endoscopic combined medication regimen.Methods 200 liver cirrhosis patients with EGVB treated in our hospital from January 30,2021 to January 30,2023 were selected and divided into observation group and control group with 100 cases each randomly.The control group was treated with simple drug therapy,and the observation group was treated with endoscopic combined drug therapy.The clinical efficacy of the two groups was compared,and the risk factors of rebleeding in liver cirrhosis patients with EGVB were determined by univariate and multivariate Logistic regression analysis.Results The total effective rate of observation group was higher than that of control group(92.00%VS 71.00%)(P<0.05).The proportion of patients treated with endoscope combined with drugs in the rebleeding group was lower than that in the non-rebleeding group(31.25%VS 73.86%)(P<0.05).There was no significant difference in other baseline data between the two groups(all P>0.05).The levels of albumin and sodium in rebleeding group were(24.31±3.87)g·L^(-1)and(126.02±10.71)mmol·L^(-1),respectively,which were lower than those in no rebleeding group(31.50±4.56)g·L^(-1)and(138.02±12.45)mmol·L^(-1)(all P<0.05).Multivariate Logistic regression analysis confirmed that the risk factors for rebleeding in EGVB patients with cirrhosis included simple drug treatment,decreased albumin and decreased blood sodium(OR=1.862,2.425,2.661,P<0.001).Conclusion The clinical efficacy of endoscopic combined drug therapy for EGVB in liver cirrhosis is better,while patients with simple drug therapy and low albumin and sodium levels have a higher risk of rebleeding.

关 键 词：肝硬化 食管胃底静脉曲张 破裂出血 内镜 再出血 危险因素 

分 类 号：R459.4[医药卫生—治疗学]