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目的探讨肝硬化并上消化道出血(UGH)患者预后的影响因素。方法 回顾性分析2003年6月至2009年6月我科196例肝硬化并UGH患者的临床资料。根据患者预后分为生存组与死亡组,比较两组病例的出血病因、既往出血史、24h内再出血、肝功能Child-Pugh分级、并发症(腹水、肝性脑病、肝肾综合征)、血常规(PLT、Hb)、重要生化指标(TBIL、ALB、Cr)及凝血相关指标(PT、TT、aPTT)等因素。结果 死亡组出血原因中食管胃静脉曲张出血发生率高于生存组,门脉高压性胃病出血发生率低于生存组(P<0.01);两组在上述其他观察指标间差异均有统计学意义(P<0.05,P<0.01)。结论 出血病因、既往出血史、24h内再出血、肝功能分级、并发症、重要生化指标(PLT、Hb、TBIL、ALB、Cr)及凝血因子水平均影响肝硬化并上消化道出血患者的转归,可作为评价此病预后的重要指标。
Objective To investigate the influencing factors of prognosis in patients with cirrhosis and upper gastrointestinal hemorrhage (UGH). Methods The clinical data of 196 patients with cirrhosis and UGH from June 2003 to June 2009 were retrospectively analyzed. According to the prognosis of patients, the patients were divided into survival group and death group. The causes of hemorrhage, previous history of bleeding, rebleeding within 24 h, Child-Pugh classification of liver function, complication (ascites, hepatic encephalopathy, hepatorenal syndrome) Blood routine (PLT, Hb), important biochemical indicators (TBIL, ALB, Cr) and coagulation related indicators (PT, TT, aPTT) and other factors. Results The incidence of hemorrhage of esophageal and gastric varices in the death group was higher than that in the survival group, and the incidence of portal hypertensive gastropathy was lower in the death group than in the survival group (P <0.01). There was significant difference between the other groups (P <0.05, P <0.01). Conclusion The causes of hemorrhage, history of previous hemorrhage, rebleeding within 24 h, grading of liver function, complications, important biochemical parameters (PLT, Hb, TBIL, ALB, Cr) and blood coagulation factors all affect the progression of cirrhosis and upper gastrointestinal bleeding Go, can be used as an important indicator to evaluate the prognosis of the disease.