肝硬化食管胃底静脉曲张出血的护理

目的预防肝硬化食管胃底静脉曲张的破裂出血,降低再出血的复发率,减少病死率。方法通过分析肝硬化食管胃底静脉曲张破裂出血的诱发因素,针对不同诱因采取预防性护理。结果根据肝硬化食管胃底静脉曲张破裂出血的相关因素,培养患者的良好生活习惯,提高了其医从性,降低了再出血的复发率。结论肝硬化食管胃底静脉曲张再出血的预防性护理,对于降低再出血的复发率、减少病死率起到了显著的作用。     

肝硬化并食管胃底静脉曲张破裂出血的诱因分析及护理对策

目的探究肝硬化并食管胃底静脉曲张破裂出血的诱因分析及护理对策。方法从2017年4月至2018年4月在我院治疗肝硬化并食管胃底静脉曲张破裂出血患者60例作为研究对象,收集疾病资料,研究分析出血诱因,根据不同诱因采取针对性护理方法。结果通过研究发现,肝硬化并食管胃底静脉曲张出血诱主要原因为饮食不当、疲劳过度、情绪变化、腹压过高等。结论对肝硬化并食管胃底静脉曲张劈破裂出血诱因及时分析,采取合理的护理方式,控制食管胃底静脉曲张破裂导致出血的概率。     

思他宁治疗肝硬化食管胃底静脉曲张破裂出血79例临床疗效分析

食管胃底静脉曲张破裂出血是肝硬化门脉高压症致命的并发症之一。我院近年来应用生长抑素 四肽-思他宁治疗肝硬化食管胃底静脉曲张破裂出血疗效满意。现报告如下:1材料与方法1.1病例选择:132例肝硬化食管胃底静脉曲张破裂出血病人随机分为两组。治疗组79例,男53例,女26例,年龄2     

肝硬化皮肤蜘蛛痣与食管胃底静脉曲张破裂出血关系的探讨

肝硬化皮肤蜘蛛痣与食管胃底静脉曲张破裂出血关系的探讨２５７３００山东省广饶县人民医院王敬东肝硬化皮肤蜘蛛痣与食管胃底静脉曲张破裂出血之间的联系，国内报道尚少。为此，笔者对１４８例肝硬化患者进行分析，以探讨蜘蛛痣与食管胃底静脉曲张破裂出血之间的关系。１...     

内镜联合药物诊治肝硬化食管胃底静脉曲张破裂出血的疗效及再出血的危险因素分析

目的研究在肝硬化食管胃底静脉曲张破裂出血中采取内镜联合药物诊治的疗效,评价再出血危险因素。方法回顾性分析2014年7月至2017年7月收入的72例肝硬化食管胃底静脉曲张破裂出血患者涉及的资料,均开展内镜联合药物治疗,分析患者再出血危险因素。结果 2型食管胃静脉曲张患者、1型食管胃静脉曲张+2型食管胃静脉曲张患者再出血率、静脉曲张复发率、静脉曲张消失率对比1型食管胃静脉曲张,P <0.05,统计学存在数据分析意义;Child-Pugh评分、门静脉内径属于再出血独立且危险的相关因素,血钠浓度和白蛋白浓度是再出血保护因素。结论将内镜联合药物诊治应用在肝硬化食管胃底静脉曲张破裂出血患者中存在确切效果,1型食管胃静脉曲张效果最为明显。     

醋酸奥曲肽注射液治疗食道静脉破裂出血

食管胃底静脉曲张破裂出血是肝硬化门脉高压的严重并发症,也是肝硬化患者的主要死因。醋酸奥曲肽注射液是人工合成的一种生长抑素类似物,是治疗门脉高压并发食管胃底静脉曲张破裂出血新的治疗手段[1],为观察其临床疗效,回顾分析奥曲肽与垂体后叶素治疗食管胃底静脉曲张破裂出血     

探讨奥曲肽治疗急性肝硬化并食管-胃底静脉曲张破裂出血的疗效

目的探讨奥曲肽治疗肝硬化并食管-胃底静脉曲张破裂出血引起急性上消化道出血的疗效。方法对43例肝硬化并食管-胃底静脉曲张破裂出血（EV）患者，观察应用奥曲肽后24h止血情况。结果所有患者24h止血率为88．4％，治疗过程均未见毒副反应。结论本实验表明奥曲肽治疗肝硬化并食管-胃底静脉曲张破裂出血的急性上消化道出血疗效显著，安全可靠，在急救过程中可考虑优先选用。     

立止血治疗食管胃底静脉曲张破裂出血效果的临床观察

<正>食管胃底静脉曲张破裂出血是肝硬化最危急的并发症之一,首次出血病死率高达50%~70%,反复出血发生率在80%左右。严重时常危及生命,因此,准确的诊断和对治疗疗效的判断至关重要,如何有效控制出血和预防反复出血是临床医师应该考虑的问题。立止血是用于治疗肝硬化并发食管胃底静脉曲张破裂出血的酶性止血针剂,本文应用立止血治疗69例食管胃底静脉曲张破裂出血患者,以观察其治疗效果、不良反应和安全性等情况。结果表明,立止血治疗食管胃底静脉     

生长抑素联用埃索美拉唑治疗食管-胃底静脉曲张破裂出血128例分析

<正>肝硬化上消化道大出血多数是由于食管-胃底静脉曲张破裂出血所致,且食管-胃底静脉曲张破裂出血是肝硬化失代偿期的严重并发症和主要的死亡原因之一,临床上应予积极抢救。2007—2009年我们医院应用生长抑素(施他宁,北京默克公司生产)联用埃索美拉唑(esomeprazole,耐信,无锡阿斯利康公司生产)治疗食管-胃底静脉曲张破裂出血128例,疗效显著,报告如下。     

食管胃底静脉曲张破裂出血的内科综合治疗

食管胃底静脉曲张破裂出血是肝硬化门脉高压患者的严重并发症,亦是肝硬化患者主要死亡原因之一。我科自2001年～2006年3月共收治肝硬化病人50余例,其中46例病人发生上消化道出血,而食管胃底静脉曲张破裂出血患者39例,并有16例病人反复出血而多次入院治疗。现将此39例病人的治疗过程及结果做回顾性分析,探讨肝硬化食管胃底静脉曲张破裂出血的内科综合治疗方法。     

生长抑素联合特利加压素治疗肝硬化急性食管静脉曲张破裂出血患者的临床观察

目的:观察生长抑素联合特利加压素治疗肝硬化急性食管静脉曲张破裂出血患者的临床疗效。方法:将我院住院肝硬化急性食管静脉曲张破裂出血患者83例随机分为联合治疗组与生长抑素组。联合治疗组41例应用生长抑素(首剂静脉注射250μg后,250μg.h-1静脉持续泵入)+特利加压素(首剂静脉注射2mg后,间隔4h静脉注射1mg)治疗;生长抑素组42例单用生长抑素(首剂静脉注射250μg后,250μg.h-1静脉持续泵入)。2组给药时间维持24～48h。观察2组临床疗效、止血时间、输血量再出血率、死亡率和不良反应。结果:治疗后,联合治疗组临床疗效显著高于生长抑素组(P<0.05);止血时间、输血量、再出血率及死亡率显著低于生长抑素组(P<0.05)。联合治疗组不良反应发生率为4.88%,生长抑素组未见明显不良反应,2组比较差异无统计学意义(P>0.05)。结论:生长抑素联合特利加压素治疗肝硬化急性食管静脉曲张破裂出血的疗效优于单用生长抑素,且安全性较好。     

肝硬化食管静脉曲张内镜下套扎27例临床疗效分析

目的探讨采用胃镜套扎止血治疗肝硬化食管静脉曲张破裂出血患者的疗效。方法对27例肝硬化患者进行常规的胃镜检查,确诊食管静脉曲张程度,随后在胃镜下对曲张静脉进行急诊、择期单次或多次套扎,其中7例食管静脉曲张破裂出血患者进行急诊胃镜检查并行胃镜下套扎术,20例进行择期胃镜下套扎术。结果27例肝硬化食管静脉曲张套扎术患者中25例（92.6%）在术后2~3周复查胃镜,静脉曲张程度均明显减轻,部分患者静脉曲张完全消失,急诊抢救及择期胃镜下套扎术止血成功率均在90%以上。结论胃镜下食管静脉曲张套扎术是治疗食管静脉曲张破裂出血及预防出血的有效措施。     

Review article: current endoscopic therapeutic options in the management of variceal bleeding

Variceal bleeding is a frequent and life-threatening complication of portal hypertension. The first episode of variceal bleeding is not only associated with a high mortality, but also with a high recurrence rate in those who survive. Therefore, many studies and randomized clinical trials have focused on different therapeutic strategies aiming to prevent the first episode of variceal bleeding (primary prophylaxis), to control haemorrhage during the acute bleeding episode (emergency treatment), and to prevent re-bleeding (secondary prophylaxis). These strategies involve pharmacological, endoscopic, surgical, and interventional radiological modalities. This review concentrates on the clinical aspects of the endoscopic modalities used to treat oesophageal variceal haemorrhage, including variceal injection sclerotherapy, variceal band ligation, and the use of tissue adhesives (glue) and their substitutes. We also draw conclusions from the available literature regarding the use of endoscopic modalities in primary prophylaxis, emergency treatment, and secondary prophylaxis of variceal re-bleeding. The management of gastric varices and variceal bleeding during pregnancy is also addressed.     

食管静脉曲张内镜下套扎及硬化等联合治疗的比较观察

目的对比观察内镜下套扎(EVL)后追加硬化剂注射(EV S)即EVL EV S联合序贯治疗与单纯EVL及EV S治疗食管静脉曲张的疗效。方法120例慢性乙型病毒性肝炎后肝硬化并食管静脉曲张破裂出血(EVB)患者随机分成三组,各为46例、38例、36例分别接受EVL、EV S、EVL EV S治疗。对三组治疗后急诊止血率、静脉曲张消失率、再发出血率、静脉曲张复发率、总并发症发生率进行对比。结果三组急诊止血率、静脉曲张消失率均在90%以上,比较无显著差异(P>0.05),再发出血率、静脉曲张复发率三组比较,EVL组明显高于EV S及EVL EV S组,总并发症发生率三组中EV S组明显高于EVL及EVL EV S组(P<0.05)。结论EVL EV S疗效优于单纯EV S、EVL,是目前治疗EVB较理想的方法。     

Hepatic venous pressure gradient measurements to assess response to primary prophylaxis in patients with cirrhosis: a decision analytical study

BACKGROUND: The measurement of the hepatic venous pressure gradient may identify a suboptimal response to beta-blockers in patients with varices at risk for bleeding. However, the cost-effectiveness of routine hepatic venous pressure gradient measurements to guide primary prophylaxis has not been examined. METHODS: We used decision analysis to evaluate two hepatic venous pressure gradient measurement strategies relative to standard beta-blocker therapy in a hypothetical cohort of patients with high-risk varices: (i) hepatic venous pressure gradient measurement 4 weeks after the initiation of beta-blocker therapy; and (ii) hepatic venous pressure gradient measurement prior to and 4 weeks after the initiation of beta-blocker therapy. The total expected costs, variceal bleeding episodes and deaths were calculated over a 1-year time horizon. RESULTS: Beta-blocker therapy was associated with total costs of $1464, seven variceal bleeding episodes, one variceal bleeding episode-related death and 15 deaths. One hepatic venous pressure gradient measurement was associated with total costs of $5015, four variceal bleeding episodes, one variceal bleeding episode-related death and 15 deaths. Two hepatic venous pressure gradient measurements were associated with total costs of $8657, four episodes of variceal bleeding, one variceal bleeding episode-related death and 15 deaths. Compared with beta-blocker therapy alone, the incremental costs per variceal bleeding episode prevented and death averted were, respectively, $108 185 and $355 100 (one hepatic venous pressure gradient measurement) and $202 796 and $719 300 (two hepatic venous pressure gradient measurements). The results were sensitive to the time horizon of the analysis, the probability of bleeding whilst on beta-blockers and the cost of hepatic venous pressure gradient measurement. CONCLUSION: Hepatic venous pressure gradient measurement to guide primary prophylaxis is an expensive strategy for reducing variceal bleeding or death, especially in patients with limited life expectancy, such as those with advanced, decompensated cirrhosis.     

二腔一囊管压迫并用内镜硬化治疗食管静脉曲张破裂出血

目的 探讨食管静脉曲张破裂出血安全满意的治疗方法。方法 食管静脉曲张破裂出血时，采用二腔一囊管压迫，同时应用内镜下硬化治疗术。结果 所有病例的出血得到控制，止血成功率100％。曲张静脉完全消失，平均硬化治疗3次，无其他严重并发症。结论 食管静脉破裂出血时，采用二腔一囊管压迫，同时联合应用硬化治疗，止血迅速，疗效可靠，无严重并发症，值得临床推广。     

内镜紧急结扎术治疗食管静脉曲张破裂出血

目的;探讨内镜紧急结扎术治疗食管静脉曲张破裂出血的疗效。方法：２４例急诊胃镜证实食管静脉曲张破裂出血的患者,立即内镜下行ＥＶＬ治疗,并与同期２９例预防性ＥＶＬ疗效比较。结果：急诊止血率达９５．８％,与预防性ＥＶＬ比较,静脉曲张消失率及再出血率无显著性差异。     

内镜套扎术联合药物治疗食管静脉曲张破裂出血36例

目的：探讨食管静脉曲张套扎术（EVL）结合药物综合治疗食管静脉曲张破裂出血的ll缶床效果。方法：消化科自1996年7月～2007年6月,收治肝硬化食管静脉曲张破裂出血病人36例,均采用EVL联合应用生长抑素及奥美拉唑治疗。结果：生长抑素及奥美拉唑联合内镜套扎治疗36例肝硬化并食道静脉曲张破裂出血患者,短期止血成功率达100％。结论：EVL联合应用生长抑素及奥美拉唑综合治疗,近期止血成功率高、再出血发生率低、并发症少。     

Vapreotide: a somatostatin analog for the treatment of acute variceal bleeding

Background: Portal hypertension is a clinically important consequence of cirrhosis that can lead to morbidities such as variceal bleeding, hepatic encephalopathy and ascites. All of these outcomes carry high mortality rates. There have been several drugs created to assist with endoscopic therapy for the treatment of acute variceal bleeding. Recently, vapreotide has been studied in patients to evaluate its efficacy as treatment for acute variceal hemorrhage. Although no comparisons have been made between vapreotide and other somatostatin analogues, this drug has been shown to have efficacy in the control of acute variceal bleeding as well as reducing the risk of recurrent bleeding and death, especially when started prior to endoscopy. Objective: This paper reviews the literature regarding the basic science and clinical efficacy of vapreotide in acute variceal bleeding. Methods: We used a PubMed/Medline search in order to review the literature regarding the drug, vapreotide. Results/conclusions: Vapreotide appears to have benefit in the control of acute variceal bleeding. It is easy to administer and has few side effects, which are minor. These findings endorse the need for future trials to evaluate vapreotide and its use in acute variceal hemorrhage, a morbidity among patients with cirrhosis.     

垂体后叶素联合硝酸甘油、酚妥拉明治疗食管-胃底静脉曲张破裂出血的临床观察与分析

目的：观察与分析垂体后叶素联合硝酸甘油、酚妥拉明对肝硬化门静脉高压引起的食管-胃底静脉曲张破裂出血的治疗效果。方法：选择2006年5月～2010年12月本院内科确诊为肝硬化门静脉高压引起食管-胃底静脉曲张破裂出血患者30例,采用垂体后叶素、硝酸甘油、酚妥拉明静脉滴注。结果：30例患者72h止血者26例,有效率为86.7%。结论：垂体后叶素联合硝酸甘油、酚妥拉明治疗肝硬化门静脉高压引起的食管-胃底静脉曲张破裂出血疗效显著。