【摘要】 目的探讨慢加急性肝衰竭患者合并食管胃静脉曲张破裂出血行急诊内镜下止血治疗的相关影响因素。方法选取2016年1月—2018年12月北京世纪坛医院和解放军总医院第五医学中心急诊内镜治疗的慢加急性肝衰竭合并食管胃静脉曲张破裂出血患者共51例,其中止血成功26例,止血失败25例。比较两组间的一般资料、内镜下静脉曲张分级及出血表现、血液生化指标、超声表现、Child-Pugh分级及MELD评分,分析其止血疗效的影响因素。计量资料两组间比较采用t检验或Mann-Whitney U秩和检验,计数资料两组间比较采用χ~2检验,多因素分析采用logisitc回归分析。结果本组患者成功止血26例,止血成功率为51 %。两组性别、年龄、肝硬化病因、是否合并肝癌、是否合并门静脉血栓、是否首次出血、WBC、Hb、PLT、PTA、ALT、TBil、Alb、ChE、MELD评分、胃镜下出血部位、出血表现等差异均无统计学意义(P值均>0.05)。止血成功组病程时间长于失败组(t=2.760,P=0.008),门静脉直径和内镜下曲张静脉直径均小于失败组(t=-4.847、χ~2=-6.590,P值均<0.05),失败组Child-Pugh C级比例明显高于成功组(χ~2=5.684,P=0.017)。肝硬化病程(OR=0.913,95% CI:0.838-0.994)、门静脉直径(OR=1.925,95% CI:1.516～2.443)和曲张静脉直径(OR=23.254,95% CI:2.250-240.352)是影响内镜下止血疗效的独立因素(P值均<0.05)。结论慢加急性肝衰竭患者急诊内镜止血成功率较低,肝硬化病程、门静脉直径和曲张静脉直径是影响内镜下止血疗效的独立因素。更多还原

【Abstract】 Objective To investigate the influencing factors for the clinical effect of emergency endoscopic therapy in the treatment of patients with acute-on-chronic liver failure and gastroesophageal variceal bleeding.Methods A total of 51 patients with acute-on-chronic liver failure and gastroesophageal variceal bleeding who underwent emergency endoscopic therapy in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to December 2018 were enrolled,among whom 26 had successful hemostasis and 25 had failed hemostasis.The two groups were compared in terms of general information,varices grade and bleeding manifestations under endoscope,blood biochemical parameters,ultrasound findings,Child-Pugh class,and Model for End-Stage Liver Disease(MELD) score,and the influencing factors for the outcome of hemostasis were analyzed.The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups;the logistic regression model was used to perform the multivariate analysis.Results Of all patients,26 achieved successful hemostasis,with a success rate of hemostasis of 51%.There were no significant differences between the two groups in sex,age,etiology of liver cirrhosis,presence or absence of liver cancer,presence or absence of portal vein thrombosis,bleeding for the first time or not,white blood cell count,hemoglobin,platelet count,prothrombin time activity,alanine aminotransferase,total bilirubin,albumin,cholinesterase,MELD score,and bleeding site and bleeding manifestations under gastroscope(all P>0.05).Compared with the failed hemostasis group,the successful hemostasis group had a significantly longer course of disease(t=2.760,P=0.008) and significantly larger portal vein diameter and diameter of varicose veins under endoscope(t=-4.847,χ~2=-6.590,both P <0.05),and the failed hemostasis group had a significantly higher proportion of patients with Child-Pugh class C disease than the successful hemostasis group(χ~2=5.684,P=0.017).Course of livercirrhosis(oddsracio [OR]=0.913,95% confidence interval [CI]:0.838-0.9 94,P <0.05),portal vein diameter(OR=1.925,95% CI:1.516-2.443,P <0.05),and diameter of varicose veins(OR-23.254,95% CI:2.250-240.352,P <0.05) were independent influencing factors for the clinical effect of endoscopic hemostasis.Conclusion There is a relatively low success rate of emergency endoscopic hemostasis in patients with acute-on-chronic liver failure,and course of liver cirrhosis,portal vein diameter,and diameter of varicose veins are independent influencing factors for the clinical effect of endoscopic hemostasis.更多还原