食管静脉曲张套扎术后早期再出血的危险因素的Meta分析

发布时间：2019-01-04 07:44

【摘要】：目的:综合分析EVL术后早期再出血的危险因素,为制定相关的预防措施提供决策依据。方法:应用Meta分析的方法,对有关EVL术后早期再出血的危险因素相关的7篇文献进行综合分析,计算各个可疑危险因素的合并比值比(odds ratio, OR)或加权均数差(weighted mean difference, WMD)及其95%可信区间(confidence interval CI)。结果： Grade分级重度[OR=26.14，95%CI(12.42,55.00)]、Child-Pugh分级C[OR=32.42，95%CI(14.25,73.75)]、腹水量(中量-大量)[OR=245.37，95%CI(108.35,555.64)]、门静脉血栓[OR=8.12，95%CI(4.50,14.65)]、既往有糖尿病病史[OR=2.77，95%CI(1.40,5.47)]、门静脉宽度[WMD=2.45，95%CI(0.99,3.92)]、曲张静脉根数[WMD=1.37，95%CI(1.01,1.72)]、结扎静脉根数[WMD=1.72，95%CI(1.50,1.95)]、凝血酶原时间[WMD=3.54，95%CI(2.24,4.84)]、丙氨酸氨基转移酶[WMD=6.48，95%CI(1.36,11.59)]、总胆红素[WMD=8.01，95%CI(3.98,12.04)]、套扎所用皮圈数目[WMD=1.49，95%CI(1.33,1.64)]为EVL术后早期再出血的危险因素；而Grade分级中度[OR=0.06，95%CI(0.03,0.12)]、Child-Pugh分级A级[OR=0.24，95%CI(0.15,0.37)]或B级[OR=0.26，95%CI (0.17,0.39)]、腹水量(无-少量)[OR=0.00，，95%CI (0.00,0.01)]、凝血酶原活动度[WMD=-11.03，95%CI(-15.96,-6.09)]、血红蛋白[WMD=-13.72，95%CI (-25.09,-2.35)]为其保护因素；Grade分级轻度与其关系不显著。结论：通过改善肝功能Child-Pugh分级、减少腹水量、改善凝血功能等方法,一定程度上可降低EVL术后早期再出血的风险。
[Abstract]:Objective: to analyze the risk factors of early rebleeding after EVL and to provide decision basis for making relevant preventive measures. Methods: by using Meta analysis, 7 articles related to risk factors of early rebleeding after EVL were analyzed, and the combined ratio of each suspected risk factor was calculated compared with (odds ratio, OR) or weighted mean value difference (weighted mean difference,). WMD) and its 95% confidence interval (confidence interval CI). Results: the Grade grade was severe [OR=26.14,95%CI (12.42) 55.00], the Child-Pugh grade C [OR=32.42,95%CI (14.2573.75)], the ascites volume (medium dose-mass) [OR=245.37,95%CI (108.35555.64)]. Portal vein thrombosis [OR=8.12,95%CI (4.50 卤14.65)], history of diabetes mellitus [OR=2.77,95%CI (1.40v 5.47)], portal vein width (WMD=2.45,95%CI (0.99v 3.92)]. The number of varicose vein roots [WMD=1.37,95%CI (1.01 ~ 1.72)], ligated vein roots [WMD=1.72,95%CI (1.50 ~ 1.95)], prothrombin time [WMD=3.54,95%CI (2.24 ~ 4.84)], Alanine aminotransferase [WMD=6.48,95%CI (1.36 ~ 11.59)], total bilirubin [WMD=8.01,95%CI (3.98 ~ 12.04)], The number of skin rings used for ligation [WMD=1.49,95%CI (1.33 卤1.64)] was a risk factor for early rebleeding after EVL. Grade grade [OR=0.06,95%CI (0.03 ~ 0.12)], Child-Pugh grade A [OR=0.24,95%CI (0.150.37)] or B grade [OR=0.26,95%CI (0.170.39)], Ascites (nil) [OR=0.00,95%CI (0.000. 01)], prothrombin activity [WMD=-11.03,95%CI (-15.96-6.09)], hemoglobin [WMD=-13.72,95%CI (-25.09, -25.09)] -2.35)] as a protective factor; There was no significant correlation between mild Grade grading and Grade grade. Conclusion: the risk of early rebleeding after EVL can be reduced to some extent by improving Child-Pugh grade of liver function, reducing ascites and improving coagulation function.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2

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