肝硬化患者上消化道出血危险因素与预后影响因素分析

发布时间：2019-03-16 15:25

【摘要】：目的探讨肝硬化合并上消化道出血的危险因素,分析出血患者影响预后的相关因素,为临床治疗提供参考。方法选取2008年6月-2014年8月566例肝硬化患者按照是否合并出血分为出血组320例和未出血组246例,分析两组患者凝血功能、幽门螺杆菌感染、肝功能评分等指标得出危险因素;将出血组再分为死亡组48例和生存组272例,对比两组患者出血次数、合并症等指标,研究影响预后的相关因素。结果单因素、多因素分析表明,胃左静脉内径、食管静脉曲张、腹水、PT16s是上消化道出血的危险因素;肝硬化并上消化道出血预后独立危险因素为失血性休克(OR=3.652,95%CI=1.12~3.13,P=0.022)、胃底静脉曲张破裂(OR=7.744,95%CI=4.43~11.53,P=0.008)、合并症(OR=4.872,95%CI=2.64~7.57,P=0.010)。结论胃左静脉内径、腹水、食管胃静脉曲张、PT16s是上消化道出血的危险因素;出血量、反复出血、合并肝性疾病、肝功能Child C级均是预后的影响因素。
[Abstract]:Objective to explore the risk factors of liver cirrhosis complicated with upper digestive tract hemorrhage, and to analyze the related factors affecting the prognosis of patients with hemorrhage, so as to provide reference for clinical treatment. Methods from June 2008 to August 2014, 566 patients with liver cirrhosis were divided into bleeding group (320 cases) and non-bleeding group (246 cases). The risk factors such as coagulation function, Helicobacter pylori infection and liver function score were analyzed. The bleeding group was divided into the death group (48 cases) and the survival group (272 cases). The bleeding times and complications were compared between the two groups to study the related factors affecting the prognosis. Results univariate and multivariate analysis showed that left gastric vein diameter, esophageal varices, ascites and PT16s were risk factors for upper gastrointestinal bleeding. The independent prognostic risk factors for cirrhosis with upper gastrointestinal bleeding were hemorrhagic shock (OR=3.652,95%CI=1.12~3.13,P=0.022), gastric variceal rupture (OR=7.744,95%CI=4.43~11.53,P=0.008). Complications (OR=4.872,95%CI=2.64~7.57,P=0.010). Conclusion left gastric vein diameter, ascites, esophageal gastric varicose vein and PT16s are risk factors for upper gastrointestinal bleeding, bleeding volume, recurrent bleeding, combined with hepatic diseases and liver function Child grade C are prognostic factors.
【作者单位】：浙江省平阳县人民医院外科;
【基金】：浙江省卫生厅基金资助项目(2013KYA121)
【分类号】：R575.2

【参考文献】