本文選題：食管靜脈曲張破裂出血　切入點(diǎn)：內(nèi)鏡套扎術(shù)　出處：《廣西中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:分別對內(nèi)鏡套扎術(shù)聯(lián)合生長抑素及單純內(nèi)鏡套扎術(shù)治療食管靜脈曲張破裂出血進(jìn)行回顧性分析,探討上述兩種方法對食管靜脈曲張破裂出血治療的效果及并發(fā)癥的研究,旨在為促進(jìn)對EVB的臨床治療方式的進(jìn)一步了解,評價(jià)兩種方法的效果及應(yīng)用價(jià)值,并對并發(fā)癥進(jìn)一步預(yù)防。方法:本研究回顧性分析了2013年1至2015年9月在廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院消化內(nèi)科和肝病科因肝硬化食管靜脈曲張破裂出血而行住院治療的106例患者,并分成治療組和對照組,均給予標(biāo)準(zhǔn)內(nèi)科保守治療,如止血、抑酸、抗感染、擴(kuò)容等,在抑酸劑的使用上,兩組均使用了注射用埃索美拉唑鈉治療。在此基礎(chǔ)上治療組給予了內(nèi)鏡套扎術(shù)聯(lián)合生長抑素治療,對照組給予了單純內(nèi)鏡套扎治療,分別記錄患者的臨床資料、平均套扎治療次數(shù)、均次套扎環(huán)數(shù),隨訪術(shù)后止血、再出血情況、死亡、并發(fā)癥等情況,采用統(tǒng)計(jì)學(xué)方法對數(shù)據(jù)進(jìn)行處理及分析,結(jié)合臨床效果進(jìn)行評價(jià)。結(jié)果:106例病例共分成兩組。內(nèi)鏡聯(lián)合藥物組共54例,男44例,女10例,年齡在28~67歲;內(nèi)鏡組共52例,男45例,女7例,年齡在32~66歲,兩組患者在年齡、性別、病因、肝功能分級、食管靜脈曲張程度及紅色征對比上P值均0.05,差異無統(tǒng)計(jì)學(xué)意義,兩組具有可比性。兩組止血成功率分別為96.3%、92.3%,消除率分別為3.7%、7.7%,平均每次套扎環(huán)數(shù)分別為6.74±0.620、6.83±0.474,遲發(fā)性再出血率分別為9.3%、15.4%,死亡率分別為5.56%、9.61%,P0.05,差異無統(tǒng)計(jì)學(xué)意義,兩組在止血效果、靜脈曲張消除、每次套扎環(huán)數(shù)、遲發(fā)性再出血、死亡情況上無顯著差別。兩組顯效率分別為29.6%、11.5%,平均治療療程次數(shù)上分別為2.04±0.334、2.25±0.682,早期再出血率分別為1.9%、13.5%,P0.05,差異有統(tǒng)計(jì)學(xué)意義,內(nèi)鏡聯(lián)合藥物組在起效速度上比內(nèi)鏡組更快,可以減少套扎治療次數(shù)并減少早期再出血的發(fā)生。根據(jù)兩組數(shù)據(jù)得出兩組術(shù)后不良反應(yīng)中,術(shù)后發(fā)熱、吞咽梗阻感是比較常見的不良反應(yīng),但兩組在術(shù)后發(fā)熱、胸骨后疼痛、吞咽梗阻感及惡心嘔吐的發(fā)生率比較,均為P0.05,差異無統(tǒng)計(jì)學(xué)意義。結(jié)論:通過本研究,對于肝硬化食管靜脈曲張破裂出血的患者,比較內(nèi)鏡套扎聯(lián)合生長抑素組和單純內(nèi)鏡套扎組兩組的止血成功率、平均套扎次數(shù)、平均套扎環(huán)數(shù)、再出血率、并發(fā)癥、死亡率得出下列結(jié)論:內(nèi)鏡套扎術(shù)聯(lián)合生長抑素治療組在止血效果、均次套扎環(huán)數(shù)、靜脈曲張消除率、并發(fā)癥、死亡率上與單純內(nèi)鏡組無顯著差異,但比單純內(nèi)鏡套扎治療可以減少套扎治療次數(shù),并更大程度上減輕了靜脈曲張的情況,效果更加明顯,且早期再出血率明顯低于內(nèi)鏡組。對此,臨床上可以根據(jù)患者的不同情況對這兩種治療方法進(jìn)行選擇。
[Abstract]:Objective: to study the effects and complications of endoscopic ligation combined with somatostatin and endoscopic ligation alone in the treatment of esophageal variceal bleeding.In order to promote the further understanding of the clinical treatment of EVB, to evaluate the effect and application value of the two methods, and to prevent the complications.Methods: from January 2013 to September 2015, 106 patients who were hospitalized in the Department of Digestive Medicine and the Department of liver Diseases of the first affiliated Hospital of Guangxi University of traditional Chinese Medicine for esophageal variceal hemorrhage due to cirrhosis were analyzed retrospectively.They were divided into treatment group and control group. Both groups were given standard conservative medical treatment, such as hemostasis, acid suppression, anti-infection, expansion, etc. In the use of acid suppressant, both groups were treated with esomeprazole sodium for injection.On this basis, the treatment group was treated with endoscopic ligation combined with somatostatin, while the control group was treated with simple endoscopic ligation.The data were processed and analyzed by statistical method, and the clinical effect was evaluated.Results 106 cases were divided into two groups.There were 54 patients (44 males, 10 females, aged 2867 years) in the endoscopic combined drug group, 52 patients (45 males and 7 females) in the endoscopic group, aged 32 to 66 years. The patients in the two groups were aged, sex, etiology, liver function grade, age, sex, etiology and liver function grade.The degree of esophageal varices and the red sign were both 0.05, there was no significant difference between the two groups.There was no significant difference in the number of rings per ligation, delayed rebleeding and death.The effective rate of the two groups was 29.6g / 11.5, the average treatment course was 2.04 鹵0.334U 2.25 鹵0.682, and the rate of early rebleeding was 1.9and 13.5g / P0.05respectively. There was significant difference between the two groups. The effective rate of the endoscopic combined drug group was faster than that of the endoscopic group.Can reduce the number of ligation treatment and reduce the occurrence of early re-bleeding.According to the data of the two groups, fever and dysphagia were common adverse reactions in the two groups, but the incidence of fever, poststernal pain, dysphagia and nausea and vomiting were compared between the two groups.The difference was not statistically significant (P 0.05).Conclusion: in this study, the hemostatic success rate, the average number of ligation times, the average number of ligation loops and the rate of rebleeding were compared between the endoscopic ligation combined with somatostatin group and the simple endoscopic ligation group for patients with esophageal variceal bleeding.Complications and mortality: there was no significant difference in hemostatic effect, number of times of ligation, elimination rate of varicose vein, complication and mortality of endoscopic ligation combined with somatostatin group.But compared with endoscopic ligation alone, the frequency of ligation was reduced, and the varicose vein was alleviated to a greater extent, and the rate of early rebleeding was significantly lower than that of endoscopic group.Therefore, the two treatments can be selected according to the different conditions of the patients.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R575.2

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