内镜治疗食管胃静脉曲张早期再出血的影响因素分析

目的对行内镜治疗的食管胃静脉曲张出血患者进行回顾性分析,探讨内镜治疗后早期再出血的危险因素。方法收集1995年11月-2010年12月食管胃静脉曲张出血内镜治疗的患者300例,其中治疗后早期再出血23例,按是否发生早期再出血分为再出血组和无再出血组,比较两组患者肝肾功能、血离子、血糖、静脉曲张严重程度等十余项辅助检查指标及不同内镜治疗方法与早期再出血的关系。结果男性（P=0.04）、腹水（P=0.032）、门静脉内径（P=0.046）、血肌酐（P=0.049）、血钠（P=0.033）两组间存在统计学差异。多因素分析发现,腹水（OR=3.505,95%CI：1.169～10.512,P=0.025）、血肌酐（OR=1.016,95%CI：1.002～1.031,P=0.028）是发生早期再出血的独立危险因素。结论合并腹水和血肌酐较高的患者容易发生早期再出血,这类患者于内镜治疗前后应予积极干预。

Risk factors of early rebleeding after endoscopic treatment of gastroesophageal varices

Objective To explore risk factors of early rebleeding after endoscopic treatment of gastroesophageal varices by retrospectively analyzing cases and outcomes from the China-Japan Friendship Hospital.Methods Three hundred cases of esophagus and/or gastric varices that had received endoscopic therapy between November 1995 and December 2010 were enrolled in the study.The cases were divided into two groups according to presence or absence of early rebleeding,defined as rebleeding within 24 h to six weeks of the operative procedure.Associations with variables of the endoscopic procedure,as well as laboratory and imaging findings,were analyzed by forward stepwise logistic regression analysis to identify independent risk factors of early rebleeding.Results Patients experiencing early rebleeding after endoscopic therapy were more likely to be male（P=0.04）,ascites-positive（P=0.032）,to have a larger portal vein diameter（P=0.046）,and higher levels of serum creatinine（P=0.049） and serum sodium（P=0.033）.Two significant candidate variables were identified： ascites-positivity（odds ratio（OR）=3.505,95% confidence interval（CI）： 1.169,10.512,P=0.025） and higher serum creatinine（OR=1.016,95% CI： 1.002,1.031,P=0.028）.Conclusion Early rebleeding after endoscopic therapy of gastroesophageal varices is mainly affected by the presence of ascites and higher serum creatinine.Patients with these risk factors should be paid careful attention before and after the endoscopic procedure.