本文選題：肝硬化 + 出血�。� 參考：《延安大學(xué)》2017年碩士論文

【摘要】：目的:探討肝硬化食管胃靜脈曲張(esophageal gastric varices,EGV)早期再出血的危險(xiǎn)因素,降低肝硬化食管胃靜脈曲張出血(esophageal gastric varices bleeding,EGVB)患者早期再出血的發(fā)生,改善患者預(yù)后,為臨床工作取得數(shù)據(jù)支持,獲得社會(huì)及經(jīng)濟(jì)效益。方法:收集2014年1月-2016年1月期間于陜西省人民醫(yī)院確診并經(jīng)過治療的肝硬化合并EGVB患者(325例)的臨床資料,按照其6周內(nèi)是否發(fā)生早期再出血,分為病例組及對(duì)照組,對(duì)兩組患者的臨床資料、實(shí)驗(yàn)室及影像學(xué)檢查指標(biāo)進(jìn)行比較,分析得出肝硬化EGV患者早期再出血的相關(guān)危險(xiǎn)因素。結(jié)果:325例患者中,66例(20.31%)發(fā)生再出血的患者作為病例組,259例(79.69%)未再出血的患者作為對(duì)照組。經(jīng)單因素分析得病例組與對(duì)照組之間糖尿病病史(P=0.001),血小板(platelets,PLT)(P=0.001),總膽紅素(total bilirubin,TBiL)(P=0.001),凝血酶原時(shí)間(prothrombin time,PT)(P=0.001),國(guó)際標(biāo)準(zhǔn)化比值(international normalized ratio,INR)(P=0.002),門靜脈內(nèi)徑(P=0.001),脾靜脈內(nèi)徑(P=0.039),脾臟長(zhǎng)度(P=0.004),脾臟厚度(P=0.005),脾臟大小(P=0.009),血小板與脾長(zhǎng)徑比值(P=0.001),血小板與脾大小比值(P=0.001),門靜脈血栓(portal vein thrombosis,PVT)(P=0.001),食管靜脈曲張程度(P=0.01),紅色征(P=0.008),肝功能Child-Pugh分級(jí)(P=0.004)。Logistic回歸分析得1.病例組門靜脈內(nèi)徑、脾靜脈內(nèi)徑、脾臟長(zhǎng)度、血小板與脾長(zhǎng)徑比值、TBiL、PT、INR平均值較對(duì)照組明顯升高(P0.05)。2.病例組PLT平均值較對(duì)照組低(P=0.001)。3.兩組間有無PVT、有無紅色征、肝功能Child-Pugh分級(jí)、食管靜脈曲張程度比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.食管靜脈曲張的程度與肝功能Child-Pugh分級(jí)呈正相關(guān)關(guān)系,相關(guān)系數(shù)rs=0.416,P0.05。5.對(duì)于病毒性肝硬化出血且既往無抗病毒藥物使用史的患者,進(jìn)行抗病毒治療與否與早期再出血發(fā)生率之間無相關(guān)關(guān)系(P=0.546)。6.病例組普萘洛爾的使用率明顯低于對(duì)照組(P=0.024)。7.治療方式的選擇對(duì)肝硬化早期再出血可能無顯著影響。結(jié)論:1.門靜脈內(nèi)徑、脾靜脈內(nèi)徑、脾臟長(zhǎng)度、PLT計(jì)數(shù)、血小板與脾長(zhǎng)徑比值、凝血指標(biāo)(PT、INR)及TBiL可能是肝硬化EGV患者早期再出血的危險(xiǎn)因素。2.合并PVT的肝硬化EGV患者早期再出血的風(fēng)險(xiǎn)較大。3.肝功能Child-Pugh分級(jí)、食管靜脈曲張程度是肝硬化EGVB患者早期再出血的危險(xiǎn)因素之一,肝功能Child-Pugh分級(jí)為C級(jí),食管靜脈呈重度曲張,紅色征為陽(yáng)性的肝硬化EVGB患者早期再出血的風(fēng)險(xiǎn)越大。4.肝功能Child-Pugh分級(jí)與食管靜脈曲張的程度呈相關(guān)關(guān)系,且呈正相關(guān)關(guān)系。5.對(duì)于病毒性肝硬化出血且既往無抗病毒藥物使用史的患者,進(jìn)行抗病毒治療與否與早期再出血發(fā)生率之間可能無相關(guān)關(guān)系。6.對(duì)肝硬化EGVB患者應(yīng)用普萘洛爾可顯著降低其早期再出血風(fēng)險(xiǎn)。7.在二級(jí)預(yù)防中,硬化劑注射治療(endoscopic injection sclerotherapy,EIS)與套扎治療(endoscopic variceal ligation,EVL)對(duì)肝硬化EGVB患者早期再出血發(fā)生率的影響無顯著差異。
[Abstract]:Objective: to explore the risk factors of early rebleeding in patients with esophageal and gastric varices due to cirrhosis, to reduce the occurrence of early rebleeding in patients with esophageal and gastric varices bleeding due to cirrhosis, to improve the prognosis of patients, and to obtain data support for clinical work. To obtain social and economic benefits. Methods: the clinical data of 325 cases of cirrhosis with EGVB diagnosed and treated in Shaanxi Provincial people's Hospital from January 2014 to January 2016 were collected. According to whether early rebleeding occurred within 6 weeks, the patients were divided into two groups: the case group and the control group. The clinical data, laboratory and imaging findings of the two groups were compared, and the risk factors of early rebleeding in patients with EGV were analyzed. Results among 325 cases, 66 cases (20. 31%) with rebleeding were taken as the case group (259 cases) and 79.69 cases) the patients without rebleeding were taken as the control group. The history of diabetes between the case group and the control group was analyzed by univariate analysis. The results showed that the history of diabetes between the case group and the control group was as follows: P0. 001, PLT, P0. 001, total bilirubinus, TBiLB, P0. 001, prothrombin time, P0. 001, international standard ratio, international normalized, P0. 002, P0. 001, P0. 001, P0. 039, P0. 004, P0. 004, P0. 004, P0. 004, P0. 004, P0. 001, P0. 001, P0. 001, P0. 001, P0. 039, P0. 004, P0. 004, P0. 004. The ratio of platelets to spleen length to spleen was 0.001, the ratio of platelet to spleen was 0.001, the portal vein thrombotic portal vein thromboplasmosis was PVT 0.001, the degree of esophageal varices was 0. 01, the red sign was P0. 008, and the Child-Pugh grade of liver function was 0. 004n. logistic regression analysis showed that: P0. 001, P0. 01, P0. 008, and Child-Pugh grade, P0. 004n. Logistic regression analysis of portal vein thromboembolism portal, P0. 01, P0. 001, P0. 008, and Child-Pugh grade of liver function were obtained by logistic regression analysis. Compared with the control group, the mean value of the internal diameter of portal vein, the length of spleen and the ratio of platelet to splenic length were significantly increased in the case group compared with the control group. The average value of PLT in the case group was lower than that in the control group. There were significant differences in PVT, red sign, Child-Pugh grade of liver function and degree of esophageal varices between the two groups. The degree of esophageal varices was positively correlated with Child-Pugh grade of liver function, and the correlation coefficient was 0.416% (P 0.05.5). For patients with viral cirrhosis bleeding and no history of antiviral drug use, there was no correlation between antiviral therapy and the incidence of early rebleeding. The usage rate of propranolol in the case group was significantly lower than that in the control group. The choice of treatment may have no significant effect on early rebleeding of liver cirrhosis. Conclusion 1. Portal vein diameter, splenic length and PLT count, platelet to spleen length ratio, coagulation index PTT INR) and TBiL may be the risk factors of early rebleeding in patients with EGV. Cirrhotic EGV patients with PVT have a higher risk of early rebleeding. Child-Pugh grade of liver function and degree of esophageal varices were one of the risk factors for early rebleeding in patients with liver cirrhosis and EGVB. Child-Pugh grade of liver function was grade C, esophageal vein presented severe varices. The higher the risk of early rebleeding in patients with EVGB with positive red signs. 4. Child-Pugh grade of liver function was correlated with the degree of esophageal varices, and there was a positive correlation between Child-Pugh grade and esophageal varicose degree. For patients with viral cirrhosis bleeding and no previous history of antiviral drug use, there may be no correlation between antiviral therapy and the incidence of early rebleeding. Propranolol significantly reduced the risk of early rebleeding in patients with cirrhosis of EGVB. In secondary prevention, there was no significant difference between the effect of sclerosing agent injection on the incidence of early rebleeding in patients with liver cirrhosis and the effect of ligation on the incidence of early rebleeding in patients with liver cirrhosis.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575.2

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本文編號(hào)：2022073