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目的调查我国食管静脉曲张破裂出血救治现状。方法调查全国16个城市中19家医院2005年1月1日至2006年1月1日食管静脉曲张破裂出血救治情况,将调查涉及的25种数据数量化后,建立患者资料数据库,对食管静脉曲张破裂出血救治方法及各种止血治疗方法的疗效进行统计分析,并对影响救治结果的各因素行多元Logisitc回归分析。结果共收集病历1087份,其中资料完整可供分析病历1079份,男性824例(76.4%),女性255例(23.6%)。年龄13～86岁。出血程度:轻度(<400 ml)313例(29.0%);中度(400～1500 ml)494例(45.8%);重度(>1500 ml)272例(25.2%)。全组总止血成功率为89.8%。其中采用药物治疗785例,止血成功率91.8%。三腔两囊管治疗71例,止血成功率54.9%。急诊套扎治疗37例,止血成功率83.8%。急诊硬化剂治疗77例,止血成功率94.8%。急诊外科治疗43例,止血成功率95.3%。联合治疗66例,止血成功率97.0%。不同治疗方法止血成功率差异有统计学意义(X~2=106.612,P<0.01),止血成功率由高到低,依次为联合治疗组、外科治疗组、硬化剂治疗组、药物治疗组、套扎组及三腔两囊管组。全组总死亡率为10.1%,其中出血死亡率6.6%。多元Logisitc回归分析表明,出血程度、治疗方法、肝功能分级、肝炎活动与否对止血成功率影响最大。结论我国现阶段食管静脉曲张破裂出血以轻、中度为主,药物治疗是我国现阶段食管静脉曲张破裂出血救治中最常用的方法,急诊内镜下治疗尚不普及,救治水平有了较大提高。
Objective To investigate the treatment of esophageal variceal bleeding in our country. Methods To investigate the treatment of esophageal variceal bleeding in 19 hospitals in 16 cities across the country from January 1, 2005 to January 1, 2006. After quantifying the 25 kinds of data involved in the investigation, a database of patient data was established to evaluate the esophageal varices Variceal hemorrhage treatment methods and various hemostatic treatment efficacy of statistical analysis, and the factors that affect the treatment outcome of multiple Logisitc regression analysis. Results A total of 1,087 medical records were collected. Among them, 1079 medical records were complete, 824 (76.4%) were male and 255 (23.6%) were female. Aged 13 to 86 years old. Bleeding degree: 313 (29.0%) mild (<400 ml), 494 (45.8%) moderate (400-1500 ml) and 272 (25.2%) severe (> 1500 ml). The overall success rate of total hemostasis was 89.8%. Among them, 785 cases were treated with drugs, and the success rate of hemostasis was 91.8%. 71 cases of three-chamber two cystic duct treatment, hemostasis success rate of 54.9%. Thirty-seven cases of emergency ligation treatment, hemostasis success rate of 83.8%. 77 cases of emergency sclerotherapy, bleeding success rate of 94.8%. Emergency surgery in 43 cases, hemostasis success rate of 95.3%. Combined treatment of 66 cases, hemostasis success rate of 97.0%. The success rates of hemostasis by different treatment methods were statistically different (X ~ 2 = 106.612, P <0.01), and the success rate of hemostasis was descending, followed by combination treatment group, surgical treatment group, sclerotherapy treatment group, Ligation group and three-chamber two-tube group. The overall group mortality was 10.1%, of which bleeding mortality 6.6%. Multivariate Logisitc regression analysis showed that the extent of bleeding, treatment, classification of liver function, hepatitis activity or not have the greatest impact on the success rate of hemostasis. Conclusion At present, the esophageal variceal bleeding is mild and moderate in our country. Drug treatment is the most commonly used method in the treatment of esophageal variceal bleeding in our country at present. The treatment of emergency endoscopy is not yet universal and the treatment level is larger improve.