«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《慢性病学杂志》[ISSN:1674-8166/CN:11-5900/R]

卷:

期数:

2018年6期

页码:

709-712

栏目:

论　著

出版日期:

2018-06-27

文章信息/Info

Title:

Comparison of safety and efficacy of painless esophageal variceal ligation by sedation endoscopy on liver cirrhosis patients with different liver function classification

作者:

朱蔓然;  卢如相;  郭勇杭

粤北人民医院，广东韶关512025

Author(s):

ZHU Man-ran;  LU Ru-xiang;  GUO Yong-hang

Yue Bei People’s Hospital, Shaoguan, Guangdong, 512025, China Corresponding author: ZHU Man-ran, E-mail: zhumanran1975@163.com

关键词:

肝硬化; 无痛胃镜; 肝功能; 食管静脉曲张; 内镜下套扎

Keywords:

Cirrhosis;  Painless gastroscopy;  Liver function;  Esophageal pile;  Endoscopic variceal ligation

分类号:

R571.3

DOI:

-

摘要:

目的探讨肝硬化患者不同肝功能分级行无痛胃镜食管静脉曲张套扎术（EVL） 麻醉安全性及近期疗 效，为临床治疗提供参考。方法收集粤北人民医院2009 年1 月至2017 年6 月收治的124 例肝硬化并食管静脉 曲张行无痛胃镜EVL 患者，按术前肝功能Child-Pugh分级分组，49例肝功A 级为A 组，46例B 级为B 组，29例 C 级为C 组；对比分析三组麻醉安全性指标：麻醉效果、生命体征变化（血压、心率、血氧饱和度）、严重麻醉意 外事件；近期疗效指标：手术成功率、术中大出血、术后感染、术后1个月内出血、围手术期死亡。结果三组 麻醉效果优占率比较，差异无统计学意义（χ2=1.282，P=0.548）。三组间术前、术中、术后的收缩压、舒张压、 心率、血氧饱和度比较，差异均无统计学意义（P>0.05）；各组术中、术后的血压、心率、血氧饱和度水平与本 组术前比较，差异均无统计学意义（P>0.05）。三组手术成功率、术中大出血率、术后感染率、术后1 个月内出 血率和围手术期死亡率比较，差异无统计学意义（P>0.05）。结论术前掌握好无痛胃镜套扎适应证，不同肝功 能分级麻醉均安全、麻醉效果满意，手术近期疗效可、并发症少；但肝功能C 级注意预防可控呼吸抑制。

Abstract:

Objective To compare the safety and efficacy of esophageal variceal ligation （EVL） by painless sedation endoscopy on liver cirrhosis patients with different liver function classification. Methods Totally 124 patients with liver cirrhosis and esophageal varices who prefer to EVL by painless sedation endoscopy from January 2009 to June 2017 were collected and divided into three groups according to Child-Pugh scores of liver function: group A （n=49） , group B （n=46） , group C （n=29） . Safety indicators including efficacy of sedation, changes of vital signs （heart rate, blood pressure, blood oxygen saturation） and severe anaesthesia acciden were observed. Short- term effective indicators including success rate of operation, intraoperative hemorrhage, postoperative infection, postoperative hemorrhage within 1 month, peri- operative death were observed. Results There was no significant difference among the three groups in the rate of anaesthesia effect （P>0.05） . There were no significant differences among the three groups in preoperative, intraoperative, and postoperative heart rate, blood pressure and blood oxygen saturation （P>0.05） , and there were no significant difference in blood pressure, heart rate and blood oxygen saturation before and after operation in each group （P>0.05） . There were no significant differences among the three groups in the success rate of operation, intraop-Objective To compare the safety and efficacy of esophageal variceal ligation （EVL） by painless sedation endoscopy on liver cirrhosis patients with different liver function classification. Methods Totally 124 patients with liver cirrhosis and esophageal varices who prefer to EVL by painless sedation endoscopy from January 2009 to June 2017 were collected and divided into three groups according to Child-Pugh scores of liver function: group A （n=49） , group B （n=46） , group C （n=29） . Safety indicators including efficacy of sedation, changes of vital signs （heart rate, blood pressure, blood oxygen saturation） and severe anaesthesia acciden were observed. Short- term effective indicators including success rate of operation, intraoperative hemorrhage, postoperative infection, postoperative hemorrhage within 1 month, peri- operative death were observed. Results There was no significant difference among the three groups in the rate of anaesthesia effect （P>0.05） . There were no significant differences among the three groups in preoperative, intraoperative, and postoperative heart rate, blood pressure and blood oxygen saturation （P>0.05） , and there were no significant difference in blood pressure, heart rate and blood oxygen saturation before and after operation in each group （P>0.05） . There were no significant differences among the three groups in the success rate of operation, intraop-erative hemorrhage, postoperative infection, postoperative hemorrhage within 1 month and the perioperative death rate （P>0.05） . Conclusion As long as the indications of painless EVL were grasped before operation, painless sedation endoscopy is a safe and effective sedation method, and the operation of EVL has good short-term curative effect and few complications, but controlled respiratory inhibition should be prevented in patients with Child-Pugh C grade.

参考文献/References:

[1] Dhiraj Tripathi, Adrian J Stanley, Peter C Hayes, et al. UK guidelines on the management of variceal haemorrhage in cirrhotic patients [J]. Gut, 2015,64(11):1680-1704. [2] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会 消化内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治 指南[J].中华内科杂志,2016,55(1):57-72. [3] 中华医学会消化内镜学分会食管胃静脉曲张学组.消化道静脉曲 张及出血的内镜诊断和治疗规范试行方案(2009 年)[J].中华消化 内镜杂志,2010,27(1):1-4. [4] 宋仁,陈伟庆,何璐,等. 食管静脉曲张结扎术的疗效及其与肝功 能的关系[J].中华肝脏病杂志,2010,18(12):886-889. [5] 梁艳娉,巫织娥,周小香,等. 无痛胃镜下食管静脉曲张套扎术的 安全性分析[J]. 中山大学学报(医学科学版),2014,35(4):516- 519. [6] 杨清峰,张旭,江泳,等. 无痛胃镜下套扎治疗食管静脉曲张的疗 效及安全性分析[J].蚌埠医学院学报,2011,36(12):1309-1311. [7] 郑国启,张秀刚,于永礼,等. 食管曲张静脉套扎术肝硬化分级与 异丙酚用量的相关性[J]. 实用医药杂志,2007,24(6):641- 642, 645. [8] Chiou SS, Changchien CS. Management of end- stage liver disease [J]. Transplantation Proceedings, 1993,25(5): 2948. [9] Ge PS, Runyon BA. The changing role of beta- blocker therapy in patients with cirrhosis [J]. J Hepatol,2014,60(3): 643-653. [10] Albillos A, Zamora J, Martinez J, et al. Stratifying risk in the prevention of recurrent variceal hemorrhage: Results of an individual patient meta-analysis [J]. Hepatology, 2017.66 (4):1219-1231. [11] 王进广,孔德润. 内镜干预及联合普萘洛尔预防食管静脉曲张破 裂再出血的疗效[J]. 世界华人消化杂志,2012,20(30):2944- 2950.

备注/Memo

备注/Memo:

作者简介：朱蔓然，本科，副主任医师，研究方向：消化道大出血、肝性脑病、重症胰腺炎等重大疾病的抢救 通信作者：朱蔓然，E-mail：zhumanran1975@163.com

常用功能

更新日期/Last Update: 2018-06-28