發(fā)布時(shí)間：2018-06-03 10:18

  本文選題：肝硬化 + 門(mén)靜脈高壓　； 參考：《山東大學(xué)》2014年碩士論文

【摘要】：目的： 食管靜脈曲張破裂出血是肝硬化門(mén)脈高壓癥的嚴(yán)重并發(fā)癥,出血量大,病情兇險(xiǎn),病死率高。內(nèi)鏡下食管靜脈曲張?zhí)自�術(shù)(endoscopic variceal ligation,EVL)是預(yù)防和治療食管靜脈曲張破裂出血的首選方法,但術(shù)后早期再出血的發(fā)生率較高,常危及病人生命,但是對(duì)EVL術(shù)后早期再出血的相關(guān)因素的研究分析較少,特別是其與肝靜脈壓力梯度(HVPG)之間的相關(guān)性研究。本研究將繼續(xù)分析影響EVL術(shù)后早期再出血的相關(guān)因素,特別是HVPG與EVL術(shù)后早期再出血的關(guān)系,旨在探討HVPG對(duì)EVL術(shù)后早期出血的預(yù)測(cè)作用。 材料和方法： 回顧性分析山東省立醫(yī)院東院消化內(nèi)科自2010年10月至2014年3月期間接受內(nèi)鏡下食管胃底靜脈曲張?zhí)自�治療并在套扎治療�?個(gè)月內(nèi)曾行過(guò)HVPG測(cè)定的患者共105例。收集他們住院期間的HVPG測(cè)定值,肝硬化病因、既往出血史、外科手術(shù)史及相關(guān)治療史,凝血功能、血常規(guī)、肝功生化等指標(biāo),肝性腦病、腹水等并發(fā)癥的發(fā)生情況,以及紅色征、是否合并門(mén)脈高壓性胃病等內(nèi)鏡檢查結(jié)果和套扎環(huán)數(shù)、套扎靜脈是否滲血等治療時(shí)內(nèi)鏡下所見(jiàn)等相關(guān)數(shù)據(jù),并對(duì)上述105例病人套扎后24小時(shí)至2周內(nèi)是否出血及是否發(fā)生嚴(yán)重并發(fā)癥或死亡等情況進(jìn)行隨訪。然后進(jìn)行下列兩項(xiàng)工作： 1、根據(jù)套扎后24小時(shí)至2周內(nèi)是否出血,將患者分為出血組及未出血組,計(jì)量資料采用兩樣本比較的秩和檢驗(yàn),計(jì)數(shù)資料采用卡方檢驗(yàn),尋找影響EVL術(shù)后早期再出血的獨(dú)立影響因素；出血率的多因素分析采用Logistic回歸分析,并得出相關(guān)因素的危險(xiǎn)度。 2、準(zhǔn)確性分析應(yīng)用ROC曲線分析,根據(jù)結(jié)果中各個(gè)可能切點(diǎn)的靈敏度和特異度計(jì)算Youden指數(shù)最大的點(diǎn)為臨界點(diǎn),并結(jié)合臨床計(jì)算出最佳診斷界限值。以P0.05為差異具有統(tǒng)計(jì)學(xué)意義。所有統(tǒng)計(jì)分析均通過(guò)SPSS16統(tǒng)計(jì)軟件完成,顯著性水平α=0.05。 結(jié)果： 1、經(jīng)隨訪,資料齊全的病例105例,出血組11例(10.48%),未出血組94例(89.52%)。經(jīng)統(tǒng)計(jì)分析,PT、INR、肝功分級(jí)、ALT、HVPG為EVL術(shù)后早期再出血的獨(dú)立危險(xiǎn)因素,P值分別為0.031、0.030、0.005、0.047、0.006。而兩組在性別、年齡、肝硬化病因、是否合并肝癌、是否行過(guò)脾切除或脾栓塞術(shù)、腹水級(jí)別、肝性腦病級(jí)別、既往消化道出血史、既往食管靜脈曲張?zhí)自�史、既往PTVE史、是否服用非選擇性β-受體阻斷劑(NSBBs)、冬氨酸氨基轉(zhuǎn)移酶(AST)、血清總膽紅素(TBIL)、肌配(CR)、尿素氮(BUN)、白細(xì)胞計(jì)數(shù)(WBC)、血小板計(jì)數(shù)(PLT)、血紅蛋白(Hb)、食管靜脈曲張程度、紅色征、是否合并有胃底靜脈曲張、是否有門(mén)脈高壓性胃病、是否同時(shí)行胃底靜脈曲張治療、套扎的點(diǎn)數(shù)、套扎后食管曲張靜脈是否立即消失、套扎過(guò)程中是否出血滲血、術(shù)后是否合并腹膜炎等并發(fā)癥情況沒(méi)有顯著性差異(其P值均0.05)。經(jīng)logistic回歸多因素分析,最終只有HVPG具有統(tǒng)計(jì)學(xué)意義(P=0.005)。 2、經(jīng)ROC分析,HVPG的曲線下面積是0.866,最終得出當(dāng)HVPG≥16mmHg時(shí),出血組及未出血組的術(shù)后早期出血有顯著性差異(P0.001),且曲線下面積最大為0.838,有較高準(zhǔn)確性,其敏感度為90.9%,特異度為76.6%,對(duì)預(yù)測(cè)EVL術(shù)后早期出血有統(tǒng)計(jì)學(xué)意義。 結(jié)論： 經(jīng)統(tǒng)計(jì)學(xué)分析,只有HVPG是EVL術(shù)后早期再出血的獨(dú)立危險(xiǎn)因素。對(duì)HVPG關(guān)于EVL術(shù)后早期再出血行ROC分析,得出曲線下面積(AUC)為0.866,當(dāng)HVPG≥16mmHg時(shí),AUC為0.838,有一定準(zhǔn)確性,其敏感度為90.9%,特異度為76.6%。
[Abstract]:Objective:
Esophageal variceal bleeding is a serious complication of portal hypertension of the liver cirrhosis. The bleeding amount is large, the condition is dangerous and the mortality rate is high. Endoscopic esophageal variceal ligation (endoscopic variceal ligation, EVL) is the first choice to prevent and treat esophageal variceal bleeding, but the incidence of early rebleeding after operation is high, often dangerous. And patient life, but there are few studies on the related factors of early rebleeding after EVL, especially their correlation with the hepatic venous pressure gradient (HVPG). This study will continue to analyze the related factors affecting early rebleeding after EVL, especially the relationship between HVPG and the early rebleeding after EVL, which aims to explore HVPG for EVL. Predictive effect of posterior early bleeding.
Materials and methods:
Retrospective analysis was carried out in the Department of Gastroenterology in the Eastern Hospital of Shangdong Province-owned Hospital from October 2010 to March 2014 to receive endoscopic variceal ligation of the esophageal and gastric fundus varices and 105 patients who had undergone HVPG determination within 1 months before the ligation. The values of HVPG, the etiology of liver harden, the history of previous bleeding, the history of surgery and the history of surgery were collected. Related treatment history, blood coagulation function, blood routine, liver function and other indexes, hepatic encephalopathy, ascites and other complications, red sign, endoscopic examination and ligation of portal hypertension and ligation of blood, and other related data under endoscopic treatment, and 24 small cases after ligation of the 105 patients. The following two tasks were followed up: whether bleeding occurred during the 2 weeks, and whether serious complications or death occurred.
1, according to the bleeding of 24 hours to 2 weeks after the ligation, the patients were divided into bleeding group and non bleeding group. The measurement data were compared with the rank sum test of two samples. Counting data were checked by chi square test to find independent factors affecting early rebleeding after EVL; the multiple factor analysis of bleeding rate was analyzed by Logistic regression analysis, and the correlation was obtained. The risk of factors.
2, the accuracy analysis applied the ROC curve analysis. According to the sensitivity and specificity of the possible tangent points in the results, the maximum Youden index point was calculated as the critical point, and the best diagnostic threshold value was calculated with the clinical calculation. The difference of P0.05 was statistically significant. All the statistical analysis was completed by the SPSS16 statistical software, and the significant level of alpha =0.05. was achieved.
Result錛，

本文編號(hào)：1972427