MELD评分与肝硬化食道静脉曲张破裂出血患者预后的关系

The effectiveness of treatment with somatostatin and sengstaken-blackmore tube pressure in patients of liver cirrhosis with esophageal variceal bleeding by Meld score

目的研究中末期肝病模型（model for end stage liver disease，MELD）分级评分对肝硬化食道静脉曲张破裂出血患者应用生长抑素联合三腔二囊管压迫止血的疗效预后分析。方法对77例应用生长抑素联合三腔二囊管压迫止血的肝硬化食道静脉曲张破裂出血患者的肝功能进行MELD评分，将这些患者按MELD评分分为4组其中MELD≤9分18例，10≤MELD≤19分32例，20≤MELD≤29分15例，MELD≥30分12例，对这些患者随访其存活率、死亡率及再出血发生率。结果4个组的存活率、死亡率、再出血发生率分别为（94．5％，84．6％，60％，33．3％）、（5．5％，15．6％，40％，58．3％）、（11％，25％，33．3％，66．7％），随着MELD评分的增高死亡率和再出血发生率均上升，差异有统计学意义。结论肝硬化食道静脉曲张破裂出血患者用生长抑素联合三腔二囊管压迫止血的死亡率和再出血发生率与MELD评分直接相关，提示MELD肝功能评分对肝硬化食道静脉曲张破裂出血的治疗有一定的指导作用。

Objective To analysis the effectiveness of treatment with somatostatin and sengstaken-blackmore tube pressure in patients of liver cirrhosis with esophageal variceal bleeding by Meld score. Methods Meld score was determined for 77 patients before their treatment. Among these patients the score of MELD ≤9 is 18 cases,10≤MELD≤19 is 32 cases,20≤MELD≤29 is 15 cases, MELD≥30 is 12 cases. After the treatment these patients were followed-up and their survival rates, death rates and bleeding again rates were analyzed. Results The survival rates, death rates and bleeding again rates in the four different Meld score groups were （94.5% ,84. 6% ,60% ,33.3% ） ,（5.5% ,15.6% ,40% ,66.7% ）and （11% ,25% ,33.3% ,58.3% ）.The death rates and bleeding again rates rise with the increment of the Meld score. The difference was statistically significant. Conclusion The death rates and bleeding again rates in the patients of liver cirrhosis with esophageal variceal bleeding who were treated with somatostatin and sengstaken-blackmore tube are directly correlated with the Meld score. It suggests that the Meld score has a guidance for the treatment of the patients.