TIPS治疗门静脉高压并发症预后评价的现状

经颈静脉肝内门体分流术(TIPS)已被广泛用于肝硬化门静脉高压并发症的治疗.TIPS术后增加了肝性脑病发生率,及生存较标准治疗无延长,而作为二线治疗方法.术前对患者进行评估对生存至关重要.本文就目前重要的评价TIPS预后不良的指标及模型作一综述,为临床医师选择合适的患者提供依据.     

经颈静脉肝内门体静脉分流术治疗肝硬化静脉曲张出血预后因素分析

目的 分析经颈静脉肝内门体静脉分流(TIPS)术治疗肝硬化静脉曲张出血患者的预后因素.方法 收集2003年1月至2008年12月162例行TIPS术的肝硬化静脉曲张出血患者基本资料、术前7 d内相关生化指标,定期随访观察术后情况和生存期资料.Cox回归模型评估影响预后生存的指标.结果 TIPS术成功率99%(161/162).中位随访时间21个月.Child-Pugh评分和血小板计数与生存密切相关(P值分别=0.003和0.024).Child-Pughr评分<9分者的累积生存率[75%(102/136)]高于评分≥9分者[50%(13/26),χ2=9.12,P=0.003].血小板计数>47×109/L者的累积生存率[74%(82/112)]高于≤47×109/L者[66%(33/50),χ2=4.528,P=0.033].肝功能Child-Pugh A、B、C级术后1年累积生存率分别为92%、85%、55%.结论 Child-Pugh评分和血小板计数是预测TIPS术治疗肝硬化静脉曲张出血者生存情况的独立因素,当ChildPugh评分≥9分和(或)血小板计数≤47×109/L时术后危险性增加.

Abstract：

Objective To analyze the prognostic factors in treating variceal hemorrhage patients of liver cirrhosis and portal hypertension with transjugular intrahepatic portosystemic shunt (TIPS).Methods From January 2003 to December 2008, the data of 162 variceal hemorrhage patients with liver cirrhosis and portal hypertension treated with TIPS was collected, which included basic information, biochemical examination results within 7 days before the operation, regular follow-up observation after the surgery and survival data. The survival prognostic indexes were assessed with Cox regression model. Results The successful rate of TIPS was 99% (161/162). The median follow up duration was 21 months. Child-Pugh score and blood platelet count (PLT) were closely correlated with survival (P = 0. 003 and 0. 024). The total cumulative survival rate in patients with Child-Pugh score below nine (75%, 102/136) was higher than over nine (50%, 13/26) (χ2 = 9. 12,P=0. 003).The total cumulative survival rate of patients with PLT count over 47 ×109/L (74%, 82/112) was higher than below 47 × 109/L(66 %, 33/50, χ2 =4. 528, P = 0. 033). The one year after operation cumulative survival rate of liver function Child-Pugh class A, B, and C was 92%, 85%, 55% respectively. Conclusion Child-Pugh score and platelet count are independent predictable factors for the survival of variceal hemorrhage patients with liver cirrhosis and portal hypertension treated by TIPS. The risk increase after operation when Child-Pugh score over 9 and/or PLT count less 47×109 /L.     

生长激素联合早期肠内营养治疗重症急性胰腺炎的临床效果

目的探讨生长激素联合早期肠内营养治疗重症急性胰腺炎的临床效果。方法选取该院2018年1月至2019年12月收治的100例重症急性胰腺炎患者,根据数字随机表法分为对照组和观察组,每组50例。两组均给予常规治疗,对照组在常规治疗的基础上联合生长激素治疗,观察组在对照组的基础上联合早期肠内营养治疗,比较两组应用效果。结果对照组总有效率84.00%,观察组总有效率96.00%,观察组高于对照组(P<0.05)。观察组腹痛缓解时间、血淀粉酶恢复正常时间、住院时间均少于对照组(P<0.05)。治疗后,两组血清清蛋白(ALB)和总蛋白(TP)水平均高于治疗前,且观察组均高于对照组(P<0.05)。结论生长激素联合早期肠内营养治疗的应用,对重症急性胰腺炎患者效果明显,可促进相关症状的快速缓解和恢复,以及营养状况的改善。