CAJ | 학술논문

　　目的探讨肝硬化食管静脉曲张套扎术（ EVL）后早期再出血的危险因素。方法选择我院收治的肝硬化食管静脉曲张破裂出血采用EVL治疗的患者80例，将其中发生再出血的20例设为观察组，未出血的60例设为对照组，比较分析两组临床资料，探讨术后早期再出血危险因素。结果80例患者中，早期再出血发生率为25％，其中3例死亡，均由进食不当引起，对死亡患者行内镜检查，食管曲张静脉破裂为引起早期再出血的原因。门静脉血栓、肝功能Child-Pugh分级、血红蛋白、凝血酶原时间经Logistic回归分析，均为独立危险因素（ P ＜0．01）。术后早期再出血者肝功能分级C级影响较为明显（OR＝65．0），其他依次为凝血酶原时间（OR＝33．5）、血红蛋白（OR＝22．6）、门静脉血栓（OR＝8．6）。结论依据患者的机体状况和再出血危险因素，将EVL与非选择性β受体阻断剂联合应用，可降低再出血和并发症发生率，延长患者生命，值得临床推广应用。
　　목적탐토간경화식관정맥곡장투찰술（ EVL）후조기재출혈적위험인소。방법선택아원수치적간경화식관정맥곡장파렬출혈채용EVL치료적환자80례，장기중발생재출혈적20례설위관찰조，미출혈적60례설위대조조，비교분석량조림상자료，탐토술후조기재출혈위험인소。결과80례환자중，조기재출혈발생솔위25％，기중3례사망，균유진식불당인기，대사망환자행내경검사，식관곡장정맥파렬위인기조기재출혈적원인。문정맥혈전、간공능Child-Pugh분급、혈홍단백、응혈매원시간경Logistic회귀분석，균위독립위험인소（ P ＜0．01）。술후조기재출혈자간공능분급C급영향교위명현（OR＝65．0），기타의차위응혈매원시간（OR＝33．5）、혈홍단백（OR＝22．6）、문정맥혈전（OR＝8．6）。결론의거환자적궤체상황화재출혈위험인소，장EVL여비선택성β수체조단제연합응용，가강저재출혈화병발증발생솔，연장환자생명，치득림상추엄응용。
Objective To explore early postoperative rebleeding risk factors of cirrhosis esophageal variceal ligation (EVL). Methods Eighty patients treated with EVL were divided into observation group (20 patients with postoperative rebleeding ) and con-trol group (60 patients without postoperative rebleeding ).Clinical data of both groups were compared and analyzed so as to explore ear-ly postoperative rebleeding risk factors .Results Early rebleeding incidence of 80 patients was 25%,in which 3 patients died from im-proper diet.Esophageal varix rupture was the cause of early rebleeding .Portal vein thrombosis ,liver function grade of Child-Pugh,he-moglobin,prothrombin time which were analyzed by Logistic retrospective analysis were independent risk factors ( P <0.01).Among the grades of early postoperative bleeding in liver function , grade C (OR=65.0) had obvious influence,the others were prothrombin time (OR=33.5), hemoglobin (OR=22.6) and portal hypertension(OR=8.6).Conclusion According to the patient’s organism and rebleeding risk factors ,EVL combined with non selective β-receptor blocker which has reduced rebleeding and complication rate can prolong the life of patients .