摘要
目的:结合前沿文献对肝硬化并急性上消化道出血(UGIB)病生理机制的研究进展,分析患者急救预后的危险因素。方法:纳入60例肝硬化并UGIB病历,所有患者经规范性的急救治疗后根据临床结局分为CH组(存活组)和SW组(死亡组)。在总结临床经验、前沿报道及循证资料的基础上,纳入可能对患者急救结局造成影响因素,先开展单因素分析,再予以Logistic多因素分析。结果:单因素所得:SW组患者血清PGⅠ低于CH组(P<0.05),血清G17高于CH组(P<0.05),PT长于CH组(P<0.05);SW组患者重度食管胃静脉曲张者比例、既往出血史>2次者比例、24h内再出血者比例、休克指数>1.5者比例、肝代偿重度不全者比例、并发肝性脑病者比例均高于CH组(P<0.05)。多因素所得:重度食管胃静脉曲张、既往出血史>2次、24h内再出血、休克指数>1.5、合并肝性脑病为肝硬化并UGIB急救预后的独立危险因素(P<0.05)。结论:临床上在予以肝硬化并UGIB急救中可通过对患者食管胃静脉曲张程度的判断、既往出血史的调查及24h内再出血、休克指数、并发症的观察,准确评估患者预后危险性,并合理决策急救干预方案。
Objective:To analyze the factors threatening the clinical outcome of patients with liver cirrhosis complicated with acute upper gastrointestinal hemorrhage(UGIB)by combining the research progress of the latest literature on the pathophysiological mechanism.Methods:A total of 60 patients with cirrhosis and UGIB were enrolled.All patients were divided into CH group(survival group)and SW group(death group)according to clinical outcomes after standardized emergency treatment.On the basis of summarizing clinical experience,frontier reports and evidencebased data,factors that may affect the outcome of emergency treatment were included,and univariate and Logistic multivariate analyses were performed successively.Results:The results of single factor showed that the serum PGⅠof SW group was lower than that of CH group(P<0.05),and the serum G17 of SW group was higher than that of CH group(P<0.05).The PT of SW group was longer than that of CH group(P<0.05),and the proportion of severe esophagogastric varices,the proportion of previous bleeding history>2 times,the proportion of rebleeding within 24 hours,the proportion of shock index>1.5,the proportion of severe hepatic compensatory insufficiency,and the proportion of complicated hepatic encephalopathy were higher than those of CH group(P<0.05).Multivariate analysis showed that severe esophagogastric varices,history of bleeding>2 times,rebleeding within 24 hours,shock index>1.5,combined with hepatic encephalopathy were independent risk factors for the prognosis of liver cirrhosis and UGIB(P<0.05).Conclusion:The prognosis risk of patients with cirrhosis and UGIB can be accurately evaluated by judging the degree of esophageal and gastric varices,investigating the history of previous bleeding,observing the rebleeding within 24 hours,shock index and complications,and making reasonable emergency intervention plans.
作者
郑巧慈
陈孝伟
Zheng Qiaoci;Chen Xiaowei(Yingqian Health Service Center,Changle District,Fuzhou 350200)
出处
《数理医药学杂志》
CAS
2022年第12期1809-1811,共3页
Journal of Mathematical Medicine
关键词
肝硬化
上消化道出血
急救预后
因素
Liver cirrhosis
Upper gastrointestinal bleeding
Emergency prognosis
Factors
