[1]刘立楠.肝硬化患者上消化道出血危险因素与预后影响因素分析[J].医学信息,2021,34(14):3-6.[doi:10.3969/j.issn.1006-1959.2021.14.002]
　LIU Li-nan.Analysis of Risk Factors and Prognostic Factors of Upper Gastrointestinal Bleeding in Patients with Liver Cirrhosis[J].Medical Information,2021,34(14):3-6.[doi:10.3969/j.issn.1006-1959.2021.14.002]
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肝硬化患者上消化道出血危险因素与预后影响因素分析()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
34卷
期数:
2021年14期
页码:
3-6
栏目:
出版日期:
2021-07-15

文章信息/Info

Title:
Analysis of Risk Factors and Prognostic Factors of Upper Gastrointestinal Bleeding in Patients with Liver Cirrhosis
文章编号:
1006-1959（2021）14-0003-04
作者:
刘立楠
（首都医科大学附属北京地坛医院急诊科，北京 100015）
Author(s):
LIU Li-nan
(Emergency Department,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China)
关键词:
肝硬化; 消化道出血; 胃底静脉曲张破裂; Child-Pugh分级; 凝血酶原时间
Keywords:
Liver cirrhosis; Gastrointestinal bleeding; Gastric varices rupture; Child-Pugh classification; Prothrombin time
分类号:
R657.3+1
DOI:
10.3969/j.issn.1006-1959.2021.14.002
文献标志码:
A
摘要:
目的 研究肝硬化患者上消化道出血危险因素与预后影响因素。方法 选取2017年8月~2020年8月在我院诊治的300例肝硬化患者为研究对象，依据是否出血分为出血组154例和未出血组146例，比较两组患者一般资料、血常规、凝血功能、肝功能等，采用多因素Logistic 回归法分析肝硬化患者上消化道出血危险因素。同时将出血组患者依据临床预后分为死亡组20例和生存组134例，比较两组休克指数、合并症、肝功能分级等，分析预后影响因素。结果 出血组年龄、性别与未出血组比较，差异无统计学意义（P＞0.05），出血组患者肝功能Child-Pugh分级、食管静脉曲张程度、胃左静脉内径宽度、凝血酶原时间以及腹水量与未出血组比较，差异有统计学意义（P＜0.05）；Logistic 回归分析显示，肝功能Child C 级、胃左静脉内径增宽、重度食管静脉曲张、凝血酶原时间（PT）增大、大量腹水是上消化道出血的危险因素；死亡组和存活组年龄、性别比较，差异无统计学意义（P＞0.05）；死亡组肝功能Child -Pugh 分级、食管静脉曲张程度、胃左静脉内径宽度、凝血酶原时间以及腹水量、休克指数＞1.5、合并症与未出血组比较，差异有统计学意义（P＜0.05）；Logistic 回归分析显示，休克指数＞1.5、重度食管静脉曲张、合并症为肝硬化并上消化道出血预后独立危险因素。结论 肝硬化患者存在上消化道出血的危险，胃左静脉内径增宽、重度食管静脉曲张、肝功能Child C 级、凝血酶原时间、腹水量较多是独立危险因素。失血性休克、重度食管静脉曲张、存在合并症是显著影响肝硬化并发上消化道出血预后的危险因素，临床应加强对危险因素人群的重视，以预防上消化道出血，改善上消化道出血患者临床预后。
Abstract:
Objective To study the risk factors and prognostic factors of upper gastrointestinal bleeding in patients with liver cirrhosis.Methods A total of 300 patients with liver cirrhosis who were diagnosed and treated in our hospital from August 2017 to August 2020 were selected as the research objects.According to the bleeding, they were divided into 154 cases in the bleeding group and 146 cases in the non-bleeding group. The general information, blood routine, coagulation function, liver function, etc. of the two groups were compared.Multivariate Logistic regression was used to analyze the risk factors of upper gastrointestinal bleeding in patients with liver cirrhosis.At the same time, patients in the bleeding group were divided into 20 death groups and 134 survival groups based on clinical prognosis. The shock index, comorbidities, liver function classification, etc. of the two groups were compared, and the factors affecting the prognosis were analyzed.Results There was no significant difference in age and gender between the bleeding group and the non-bleeding group (P>0.05).The Child-Pugh classification of liver function, the degree of esophageal varices, the width of the left gastric vein, the prothrombin time and the volume of ascites in the bleeding group were compared with the non-bleeding group,the differences were statistically significant (P<0.05);Logistic regression analysis showed that Child C liver function, widening of the left gastric vein diameter, severe esophageal varices, increased prothrombin time (PT), and large amounts of ascites are risk factors for upper gastrointestinal bleeding;There was no significant difference in age and gender between the death group and the survival group (P>0.05);Child-Pugh classification of liver function, degree of esophageal varices, inner diameter of left gastric vein, prothrombin time and ascites volume, shock index>1.5, comorbidities and non-bleeding group in death group compared with Child-Pugh classification, esophageal varices, the difference was statistically significant (P<0.05);Logistic regression analysis showed that shock index>1.5, severe esophageal varices, and complications were independent risk factors for the prognosis of liver cirrhosis and upper gastrointestinal bleeding.Conclusion Patients with liver cirrhosis are at risk of upper gastrointestinal bleeding. The widened inner diameter of the left gastric vein, severe esophageal varices, Child C liver function, prothrombin time, and more ascites are independent risk factors.Hemorrhagic shock, severe esophageal varices, and comorbidities are risk factors that significantly affect the prognosis of liver cirrhosis complicated with upper gastrointestinal bleeding.The clinic should pay more attention to the population of risk factors to prevent upper gastrointestinal bleeding and improve the clinical prognosis of patients with upper gastrointestinal bleeding.

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更新日期/Last Update: 1900-01-01