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目的探讨肝硬化食管静脉曲张套扎(EVL)术后早期再出血的相关危险因素。方法回顾性分析2000年1月-2016年5月收入陕西省人民医院的肝硬化食管静脉曲张并接受EVL治疗的506例患者资料,根据是否有术后早期出血分成出血组(n=38)和无出血组(n=468)。收集可能导致术后再出血的影响因素。符合正态分布的计量资料组间比较采用t检验;计数资料组间比较采用χ~2检验;独立危险因素分析采用非条件多因素logistic回归分析。结果单因素分析结果显示,2组患者在性别(χ~2=5.675)、治疗前呕血次数(t=1.335)、治疗前呕血量(χ~2=1.983)、黑便次数(t=2.984)、静脉曲张条数(t=1.083)、血清PT(t=2.182)、PTA(t=2.584)、Alb(t=1.046)、TBil(t=2.463)、AST(t=3.473)、腹水严重程度(χ~2=8.484)、Child-Pugh评分(t=1.664)、Child-Pugh分级(χ~2=15.675)、套扎点数(t=1.134)、套扎次数(t=3.902)等方面比较差异均有统计学意义(P值均<0.05)。多因素logistic回归分析结果显示,男性[比值比(OR)=1.598,95可信区间(95%CI):1.038~2.929],Child-Pugh评分>7.2(OR=2.306,95%CI:1.443~3.031),治疗前呕血:少量(OR=1.342,95%CI:1.014~2.627)、中量(OR=2.763,95%CI:1.356~4.122)、大量(OR=4.675,95%CI:2.321~6.929)等为EVL术后早期再出血的独立危险因素(P值均<0.05);Alb>31.5 g/L是EVL术后早期再出血的保护因素(OR=0.411,95%CI:0.288~0.641,P<0.05)。结论 EVL术后应加强对男性患者的健康教育,早期纠正肝功能、凝血功能异常,改善患者Alb水平,防治腹水,提高扎套术实施技术水平,以降低EVL术后早期再出血的发生率。
Objective To investigate the risk factors of early rebleeding after liver cirrhosis esophageal varices ligation (EVL). Methods A retrospective analysis of 506 patients with cirrhosis esophageal varices admitted to Shaanxi Provincial People’s Hospital from January 2000 to May 2016 was carried out according to whether there were early postoperative hemorrhage into hemorrhage group (n = 38) and No bleeding group (n = 468). Collect factors that may cause postoperative hemorrhage. The t test was used to compare the measurement data with the normal distribution. The test data were compared by Chi-square test. The independent risk factors were analyzed by non-conditional multivariate logistic regression analysis. Results The results of univariate analysis showed that there was no significant difference between the two groups in the gender (χ ~ 2 = 5.675), the number of hematemesis before treatment (t = 1.335), the amount of hematemesis (χ ~ 2 = 1.983) (T = 2.182), PTA (t = 2.584), Alb (t = 1.046), TBil (t = 2.463), AST (t = 3.473), the severity of ascites (χ ~ 2 = 8.484), Child-Pugh score (t = 1.664), Child-Pugh classification (χ ~ 2 = 15.675), ligating points (t = 1.134), ligation times (t = 3.902) The differences were statistically significant (P <0.05). The results of multivariate logistic regression analysis showed that the odds ratio (OR) was 1.598, 95 in the male (95% CI: 1.038-2.929) and Child-Pugh score was 7.2 (OR = 2.306, 95% CI: 1.443 ~ (OR = 2.363, 95% CI: 1.356-4.122), a large number of patients (OR = 4.675, 95% CI: 2.321 ~ 6.929) were independent risk factors for early rebleeding after EVL (P <0.05). Alb> 31.5 g / L was the protective factor of early rebleeding after EVL (OR = 0.411, 95% CI: 0.288-0.641 , P <0.05). Conclusions After the operation of EVL, the health education should be strengthened for male patients. The early correction of liver function and coagulation dysfunction, the improvement of Alb level, the prevention and treatment of ascites, and the improvement of the technique of banding technique should be implemented to reduce the incidence of early rebleeding after EVL.