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肝硬化非静脉曲张性上消化道出血的临床特征及治疗方法

作者：刘吉祥

单位：四川省巴中市中心医院消化内科四川巴中 636000

关键词：肝硬化上消化道出血非静脉曲张性临床特征

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出版年,卷(期):页码：2016,8(2):86-89

摘要：

摘要：目的探讨肝硬化非静脉曲张性上消化道出血患者的临床特征和治疗方法。方法对2013年8月至
2015年8月于本院诊治的380例上消化道出血患者的临床资料进行分析，根据患者病情将患者分为3组：
肝硬化非静脉曲张性上消化道出血患者为观察组（98例），肝硬化静脉曲张性上消化道出血患者为对
照组1（124例），非肝硬化非静脉曲张性上消化道出血患者为对照组2（158例）。比较3组患者的临
床资料特点、内镜检查结果以及并发症和预后情况。结果观察组患者呕血的发生率为51.02%，较对
照组1的75.00%低（P = 0.003）；观察组咖啡样呕吐物的发生率为18.37%，高于对照组1的6.45%（P =
0.001）。观察组和对照组1患者的病因（嗜酒、自身免疫特性等）、黑便、便血等发生情况以及肝功
能分级情况无统计学差异（P ＞ 0.05）。观察组血尿素氮浓度和输血量分别为（7.7 ± 3.9）mmol/L和
（10.9 ± 7.3）U，均高于对照组1的（6.8 ± 4.3）mmol/L和（7.5 ± 5.2）U。观察组患者冠心病和高血
压的发生率分别为5.10%、11.22%，均高于对照组1的4.84%和3.23%，并发症门静脉血栓的发生率为
7.14%，低于对照组1的13.71%（P = 0.029）。观察组与对照组1患者其他的常规检查结果和并发症
无统计学差异。对照组1、观察组和对照组2的再出血率分别为11.29%、8.16%和5.70%，差异有统计
学意义（P = 0.098）。对照组1死亡率最高（1.61%），3组患者在需要介入或者手术治疗方面差异无
统计学意义（P = 0.720）。结论肝硬化患者中非静脉曲张性上消化道出血的发生率较高，其中又以
十二指肠溃疡的发生率最高，常见的并发症为冠心病和高血压，发生再出血和死亡的几率较肝硬化
静脉曲张性上消化道出血患者低，因此临床上及时的内镜检查和正确的诊治方法至关重要。

Abstract: Objective To investigate the clinical features and treatment methods of liver cirrhosis patients with
non-variceal upper gastrointestinal bleeding. Methods The clinical data of 380 patients with gastrointestinal
bleeding in our hospital from August 2013 to August 2015 were analyzed. All the patients were divided
into three groups, 98 liver cirrhosis patients with non-variceal upper gastrointestinal bleeding were in the
observation group, 124 liver cirrhosis patients with variceal upper gastrointestinal bleeding were in control
group 1 and 158 patients with no liver cirrhotic and non-variceal upper gastrointestinal bleeding were in
control group 2. Clinical features, endoscopic findings, complications and prognosis were compared. Results
The incidence of vomiting in the observation group (51.02%) was lower than that in control group 1 (75.00%,
P = 0.003); the incidence rate of coffee-like vomit in observation group (18.37%) was higher than that in control
group 1 (6.45%, P = 0.001). The etiology (alcohol and autoimmune characteristics), the clinical manifestations
of black stools, blood in the stool and the grade of liver function in observation group and control group 1 had
no statistical differences (P ＞ 0.05). The blood urea nitrogen concentration and the amount of blood transfusion
in the observation group were (7.7 ± 3.9) mmol/L and (10.9 ± 7.3) U, which were higher than those in control
group 1 [(6.8 ± 4.3) mmol/L, (7.5 ± 5.2) U], respectively. The occurrence rate of coronary heart disease and hypertension in observation group were 5.10% and 11.22%, which were higher than those of in control group
1 (4.84% and 3.23%). The occurrence rate of portal vein thrombosis in observation group (7.14%) was lower
than that in control group 1 (13.71%, P = 0.029). The other routine inspection results and complications
between observation group and control group 1 had no statistical differences. The rebleeding rate in control
group 1, observation group and control group 2 were 11.29%, 8.16% and 5.70%, respectively, the difference
was statistically significant (P = 0.098). The mortality in the control group 1 was the highest (1.61%), and
the requirement of interventional or surgical treatment among the three groups had no significant difference
(P = 0.720). Conclusions The incidence rate of gastrointestinal bleeding in liver cirrhosis patients with non-
variceal upper gastrointestinal bleeding was high, in which the duodenal ulcers was the highest. The common
complications were coronary heart disease and hypertension, the incidence rate of rebleeding and death were
lower than those in liver cirrhosis patients with variceal upper gastrointestinal bleeding, so timely and correct
endoscopy diagnosis and treatment were important.

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