特利加压素减量与肝硬化食管胃底静脉再出血相关性研究

发布时间：2018-01-03 06:28

本文关键词：特利加压素减量与肝硬化食管胃底静脉再出血相关性研究　出处：《上海交通大学》2015年硕士论文　论文类型：学位论文

【摘要】：1.目的:通过收集经特利加压素治疗的肝硬化食管胃底静脉破裂出血患者的相关临床数据,探讨出血控制后特利加压素减量过程中发生再出血的危险因素,寻找可能降低再出血风险的方法,以提高评估准确度及诊治效率。2.方法:通过回顾性收集上海市瑞金医院急诊2012年10月至2014年10月就诊的经特利加压素治疗的急性肝硬化门脉高压破裂出血患者共54例,根据在特利加压素减量过程中是否发生再出血,分为未再出血组(31例),再出血组(23例)。对其基本情况及相关临床指标进行分析统计,并使用SPSS分析可能导致再出血的危险因素,同时对特利加压素的用药时间、减量方案不同与发生再出血的相关性进行分析讨论。3.结果:再出血组与未再出血组患者数据相比较,发现再出血组患者门静脉流速分别为高于未再出血组(P=0.038),脾静脉宽度大于未再出血组,凝血酶原时间长于未再出血组(P=0.019),首次出血率高于未再出血组(P=0.026)。继而根据危险因素对收集的患者进行筛选,对病情较重的患者进一步分析,发现对于病情较严重的患者,采用缓慢减量方式可减少特利加压素减量过程中再出血发生率(OR=0.75,95%CI为0.18-1.87,P=0.046)。4.结论:在临床工作中对于肝硬化食管胃底静脉破裂出血患者,经特利加压素治疗止血后,在特利加压素减量前需积极纠正凝血酶原时间;对于非首次出血的患者,发生减量后再出血率较高。门静脉B超中门静脉流速、脾静脉宽度等指标在预测减量后再出血存在一定价值。对于大多数病情较重的患者,特利加压素缓慢减量的方式或可减少再出血风险。
[Abstract]:Objective: to investigate the risk factors of rebleeding in patients with esophageal and gastric fundus vein rupture bleeding treated by Trevasopressin in order to find out the risk factors of rebleeding after bleeding control. Look for ways to reduce the risk of rebleeding. To improve the accuracy and efficiency of diagnosis and treatment. Methods:. From October 2012 to October 2014, 54 patients with acute cirrhosis and portal hypertension bleeding treated with treponopressin were collected retrospectively from the emergency department of Ruijin Hospital in Shanghai. According to whether rebleeding occurred in the course of reduction of Trevasopressin, it was divided into three groups: no rebleeding group (n = 31) and rebleeding group (n = 23). The basic situation and related clinical indexes were analyzed and analyzed. SPSS was used to analyze the risk factors for rebleeding and the duration of the administration of Trevopressin. Results: the data of patients with rebleeding group were compared with those without rebleeding group. It was found that the portal vein velocity was higher in the rebleeding group than in the non-bleeding group, the width of the splenic vein was larger than that in the non-bleeding group, and the prothrombin time was longer than that in the non-bleeding group. The first bleeding rate was higher than that of non-rebleeding group (P 0.026). Then according to the risk factors the collected patients were screened and the patients with severe condition were further analyzed and found that the patients with severe condition were found to be in a more serious condition. The rate of rebleeding during the reduction of treponectin was reduced by slow reduction. The CI was 0.18-1.87. Conclusion: in the clinical work, the patients with rupture of esophageal and gastric fundus vein of liver cirrhosis were treated with tenopressin after hemostasis. The prothrombin time should be corrected actively before the reduction of trivasopressin. For patients with non-first-time bleeding, the rate of rebleeding after reduction was higher. Portal vein velocity in portal vein B ultrasound. The width of splenic vein has a certain value in predicting rebleeding after reduction. For most of the patients with severe disease, the way of slow reduction of trivasopressin may reduce the risk of rebleeding.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R575.2

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