發(fā)布時間：2019-01-04 07:44

【摘要】：目的:綜合分析EVL術(shù)后早期再出血的危險因素,為制定相關(guān)的預(yù)防措施提供決策依據(jù)。 方法:應(yīng)用Meta分析的方法,對有關(guān)EVL術(shù)后早期再出血的危險因素相關(guān)的7篇文獻進行綜合分析,計算各個可疑危險因素的合并比值比(odds ratio, OR)或加權(quán)均數(shù)差(weighted mean difference, WMD)及其95%可信區(qū)間(confidence interval CI)。 結(jié)果： Grade分級重度[OR=26.14，95%CI(12.42,55.00)]、Child-Pugh分級C[OR=32.42，95%CI(14.25,73.75)]、腹水量(中量-大量)[OR=245.37，95%CI(108.35,555.64)]、門靜脈血栓[OR=8.12，95%CI(4.50,14.65)]、既往有糖尿病病史[OR=2.77，95%CI(1.40,5.47)]、門靜脈寬度[WMD=2.45，95%CI(0.99,3.92)]、曲張靜脈根數(shù)[WMD=1.37，95%CI(1.01,1.72)]、結(jié)扎靜脈根數(shù)[WMD=1.72，95%CI(1.50,1.95)]、凝血酶原時間[WMD=3.54，95%CI(2.24,4.84)]、丙氨酸氨基轉(zhuǎn)移酶[WMD=6.48，95%CI(1.36,11.59)]、總膽紅素[WMD=8.01，95%CI(3.98,12.04)]、套扎所用皮圈數(shù)目[WMD=1.49，95%CI(1.33,1.64)]為EVL術(shù)后早期再出血的危險因素；而Grade分級中度[OR=0.06，95%CI(0.03,0.12)]、Child-Pugh分級A級[OR=0.24，95%CI(0.15,0.37)]或B級[OR=0.26，95%CI (0.17,0.39)]、腹水量(無-少量)[OR=0.00，，95%CI (0.00,0.01)]、凝血酶原活動度[WMD=-11.03，95%CI(-15.96,-6.09)]、血紅蛋白[WMD=-13.72，95%CI (-25.09,-2.35)]為其保護因素；Grade分級輕度與其關(guān)系不顯著。 結(jié)論：通過改善肝功能Child-Pugh分級、減少腹水量、改善凝血功能等方法,一定程度上可降低EVL術(shù)后早期再出血的風(fēng)險。
[Abstract]:Objective: to analyze the risk factors of early rebleeding after EVL and to provide decision basis for making relevant preventive measures. Methods: by using Meta analysis, 7 articles related to risk factors of early rebleeding after EVL were analyzed, and the combined ratio of each suspected risk factor was calculated compared with (odds ratio, OR) or weighted mean value difference (weighted mean difference,). WMD) and its 95% confidence interval (confidence interval CI). Results: the Grade grade was severe [OR=26.14,95%CI (12.42) 55.00], the Child-Pugh grade C [OR=32.42,95%CI (14.2573.75)], the ascites volume (medium dose-mass) [OR=245.37,95%CI (108.35555.64)]. Portal vein thrombosis [OR=8.12,95%CI (4.50 鹵14.65)], history of diabetes mellitus [OR=2.77,95%CI (1.40v 5.47)], portal vein width (WMD=2.45,95%CI (0.99v 3.92)]. The number of varicose vein roots [WMD=1.37,95%CI (1.01 ~ 1.72)], ligated vein roots [WMD=1.72,95%CI (1.50 ~ 1.95)], prothrombin time [WMD=3.54,95%CI (2.24 ~ 4.84)], Alanine aminotransferase [WMD=6.48,95%CI (1.36 ~ 11.59)], total bilirubin [WMD=8.01,95%CI (3.98 ~ 12.04)], The number of skin rings used for ligation [WMD=1.49,95%CI (1.33 鹵1.64)] was a risk factor for early rebleeding after EVL. Grade grade [OR=0.06,95%CI (0.03 ~ 0.12)], Child-Pugh grade A [OR=0.24,95%CI (0.150.37)] or B grade [OR=0.26,95%CI (0.170.39)], Ascites (nil) [OR=0.00,95%CI (0.000. 01)], prothrombin activity [WMD=-11.03,95%CI (-15.96-6.09)], hemoglobin [WMD=-13.72,95%CI (-25.09, -25.09)] -2.35)] as a protective factor; There was no significant correlation between mild Grade grading and Grade grade. Conclusion: the risk of early rebleeding after EVL can be reduced to some extent by improving Child-Pugh grade of liver function, reducing ascites and improving coagulation function.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2

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