全国多中心食管静脉曲张破裂出血治疗调查分析

Survey and analysis of the treatment of esophageal variceal bleeding in multiple centers in China

目的调查我国食管静脉曲张破裂出血救治现状。方法调查全国16个城市中19家医院2005年1月1日至2006年1月1日食管静脉曲张破裂出血救治情况,将调查涉及的25种数据数量化后,建立患者资料数据库,对食管静脉曲张破裂出血救治方法及各种止血治疗方法的疗效进行统计分析,并对影响救治结果的各因素行多元Logisitc回归分析。结果共收集病历1087份,其中资料完整可供分析病历1079份,男性824例(76.4%),女性255例(23.6%)。年龄13～86岁。出血程度:轻度(<400 ml)313例(29.0%);中度(400～1500 ml)494例(45.8%);重度(>1500 ml)272例(25.2%)。全组总止血成功率为89.8%。其中采用药物治疗785例,止血成功率91.8%。三腔两囊管治疗71例,止血成功率54.9%。急诊套扎治疗37例,止血成功率83.8%。急诊硬化剂治疗77例,止血成功率94.8%。急诊外科治疗43例,止血成功率95.3%。联合治疗66例,止血成功率97.0%。不同治疗方法止血成功率差异有统计学意义(X^2=106.612,P<0.01),止血成功率由高到低,依次为联合治疗组、外科治疗组、硬化剂治疗组、药物治疗组、套扎组及三腔两囊管组。全组总死亡率为10.1%,其中出血死亡率6.6%。多元Logisitc回归分析表明,出血程度、治疗方法、肝功能分级、肝炎活动与否对止血成功率影响最大。结论我国现阶段食管静脉曲张破裂出血以轻、中度为主,药物治疗是我国现阶段食管静脉曲张破裂出血救治中最常用的方法,急诊内镜下治疗尚不普及,救治水平有了较大提高。

Objective To investigate the current treatment of esophageal variceal bleeding（EVB） in China. Methods From Jan. 1st 2005 to Jan. 1st 2006, nineteen hospitals were selected from 16 largeand middle-size cities in China. The method of treating EVB and the efficacy of treatments were collected and analyzed. The homeostatic efficacy of different therapeutic methods and the outcome of each treatment were determined by multivariate logistic regression analysis. Results A total of 1087 cases were collected, in which 1079 cases were completed and eligible for analysis. There were 824 （76.4%） males and 255 （23.6%） females, with age from 13 to 86 years old. There were 313 （29.0%） cases of mild（〈 400 ml）, 494（45.8%） cases of moderate（400-1500ml）, and 272 （25.2%）cases of severe（〉1500 ml） bleeding . Successful homeostasis was achieved in 89.8% of cases. Seven hundreds and eighty five cases were treated by medication with the homeostasis rate of 91.8%. Seventy-one cases were treated by Sengstaken-Blakemore tube（S-B tube） with the homeostasis rate of 54.9%. Thirty seven cases were treated by emergency endoscopic variceal band ligation （EVL） with the homeostasis rate of 83. 8%. Seventy seven cases were treated by endoscopic sclerotherapy with the homeostasis rate of 94. 8G. Forty three cases were treated by emergency surgical operation with the homeostasis rate of 95.3 %. Sixty-six cases were treated with combined treatment with the homeostasis rate of 97.0%. There were significant difference （x^2= 106. 612, P 〈 0.01） of the successful homeostasis rate between different treatments. Thetotal mortality was 10. 1%, and 6.6% was directly caused by bleeding. The multivariate logistic regression analysis showed that the severity of bleeding, treatment methods, liver function and the activity of hepatitis were predictive factors for successful homeostasis. Conclusions ① Most cases of EVB in China are mild and moderate in severity. ② The first line treatment for EVB is medication. Emergency endoscopic intervention has not been wildly available yet. ③ The overall management outcome of EVB has been improved.