本文選題：肝硬化 + 食管靜脈曲張��； 參考：《廣東醫(yī)學(xué)》2017年S1期

【摘要】：目的探討食管胃靜脈曲張破裂出血的危險(xiǎn)因素,分析超聲檢查在其出血預(yù)測中的意義。方法收集肝硬化合并食管胃靜脈曲張患者,彩超及臨床資料齊全者370例,其中出血組153例,未出血組217例。收集患者臨床及超聲指標(biāo)。對比兩組間指標(biāo)的差異。建立多因素logistic回歸模型探討食管胃靜脈曲張破裂出血的危險(xiǎn)因素。結(jié)果出血組與未出血組在年齡及性別組成方面差異無統(tǒng)計(jì)學(xué)意義。與未出血組相比,出血組患者腹腔積液者較多,血小板計(jì)數(shù)、Child-Pugh評分、白蛋白及凝血酶原時(shí)間均較低(P0.05)。與未出血組相比,出血組門靜脈內(nèi)徑較寬、門靜脈平均速度較慢、門靜脈血流量較大、脾靜脈內(nèi)徑較寬、胃左靜脈內(nèi)徑較寬、脾厚度較寬(P0.05)。兩組在脾靜脈平均速度及脾靜脈血流量方面差異無統(tǒng)計(jì)學(xué)意義(P0.05)。多因素logistic回歸模型結(jié)果提示血小板計(jì)數(shù)(OR 0.56;95%CI 0.05~0.81;P0.001)及白蛋白(OR 0.68;95%CI 0.12~0.91;P0.001)是食管胃靜脈曲張破裂出血的保護(hù)因素,Child-Pugh評分(OR 1.49;95%CI 1.33~3.14;P=0.020)、凝血酶原時(shí)間(OR 1.23;95%CI 1.01~3.17;P=0.032)均為其危險(xiǎn)因素。超聲指標(biāo)中門靜脈內(nèi)徑(OR 3.68;95%CI 2.15~8.53;P0.001)、脾靜脈內(nèi)徑(OR 1.45;95%CI 1.04~4.98;P=0.023)、胃左靜脈內(nèi)徑(OR 1.88;95%CI 1.04~4.78;P=0.006)以及脾厚度(OR 2.32;95%CI 1.01~5.68;P=0.001)均是食管胃靜脈曲張破裂出血的獨(dú)立危險(xiǎn)因素。結(jié)論血小板計(jì)數(shù)及白蛋白是食管胃靜脈曲張破裂出血的保護(hù)因素。Child-Pugh評分、凝血酶原時(shí)間、超聲指標(biāo)中門靜脈內(nèi)徑、脾靜脈內(nèi)徑、胃左靜脈內(nèi)徑以及脾厚度均是食管胃靜脈曲張破裂出血的危險(xiǎn)因素。臨床工作時(shí)需注意患者上述指標(biāo)的變化,減少出血風(fēng)險(xiǎn)。
[Abstract]:Objective to investigate the risk factors of esophageal and gastric variceal bleeding and to analyze the significance of ultrasonography in predicting bleeding. Methods 370 cases of cirrhosis complicated with esophageal and gastric varices were collected, including 153 cases of bleeding group and 217 cases of non-bleeding group. The clinical and ultrasonic indexes were collected. The differences between the two groups were compared. Multivariate logistic regression model was established to study the risk factors of esophageal and gastric variceal bleeding. Results there was no significant difference in age and sex composition between bleeding group and no bleeding group. Compared with the non-bleeding group, the bleeding group had more peritoneal effusion, platelet count and Child-Pugh score, albumin and prothrombin time were lower (P0.05). Compared with the non-bleeding group, the bleeding group had wider portal vein diameter, slower average portal vein velocity, larger portal vein blood flow, wider splenic vein diameter, wider left gastric vein diameter and wider splenic thickness (P0.05). There was no significant difference in the mean velocity of splenic vein and the blood flow of splenic vein between the two groups (P0.05). The results of multivariate logistic regression model showed that platelet count (OR 0.5695 CI 0.050.81 P0.001) and albumin (OR 0.6895 CI 0.120.91 P0.001) were the protective factors of esophageal and gastric variceal bleeding (OR 1.499.95 CI 1.333.14P0.020), and prothrombin time (OR 1.2395CI 1.01C 1.01C 3.17P0.032) were all the risk factors. The internal diameter of portal vein (OR 3.6895 CI 2.158.53 / P0.001), splenic vein diameter (OR 1.4595 CI 1.044.98), left gastric vein diameter (OR 1.8895CI 1.044.78P0. 006) and thickness of spleen (OR 2.3295CI 1.015.68p 0.001) were independent risk factors of esophageal variceal bleeding. Conclusion Platelet count and albumin are the protective factors of esophageal and gastric variceal hemorrhage. Child-Pugh score, prothrombin time, portal vein diameter and splenic vein diameter in ultrasound. The diameter of the left gastric vein and the thickness of the spleen were the risk factors for the bleeding of esophageal and gastric varices. Attention should be paid to the changes of the above indexes in clinical work to reduce the risk of bleeding.
【作者單位】： 廣州市白云區(qū)人民醫(yī)院超聲科;廣州市白云區(qū)人民醫(yī)院胃腸鏡科;廣州市番禺區(qū)何賢紀(jì)念醫(yī)院超聲科;廣州市白云區(qū)中醫(yī)醫(yī)院超聲科;廣州市白云區(qū)人民醫(yī)院檢驗(yàn)科;廣州市白云區(qū)人民醫(yī)院內(nèi)科;
【基金】：廣州市白云區(qū)科技項(xiàng)目(編號:2016-KZ-015)
【分類號】：R445.1;R575.2

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