肝硬化门脉高压并上消化道出血治疗方法探讨

Discussion of treatment method of cirrhotic portal hypertension and upper gastrointestinal bleeding

目的探讨肝硬化门脉高压并上消化道出血的治疗方法。方法回顾性分析128例肝硬化门脉高压并上消化道出血患者的临床资料,对不同出血类型患者予以不同治疗。结果治疗后,2周内未出现活动性出血117例,出血症状持续11例,其中因医治无效死亡3例,治疗有效率为91.4%。128例患者出血诱因分别为药物38例(29.7%),饮酒36例(28.1%),过劳20例(15.6%),精神压力21例(16.4%),诱因不明13例(10.2%)。结论肝硬化门脉高压并上消化道出血治疗时要及时明确患者的出血病因,探寻出血诱因。质子泵抑制剂(PPI)适用于治疗消化性溃疡出血患者;介入治疗适用于门脉高压性胃出血患者;生长抑素及其衍生物有助于降低门静脉压,适用于治疗食管胃底曲张静脉破裂出血患者。

Objective To investigate the treatment method of cirrhotic portal hypertension and upper gastrointestinal bleeding. Methods Retrospectively analyzed the clinical data of 128 cases patients with cirrhotic portal hypertension and upper gastrointestinal bleeding. The patients with different bleeding patterns were given with different treatment. Results After treatment, 117 cases did not appear within two weeks of active bleeding, bleeding symptoms persist for 11 cases,including 3 cases died of treatment failed, the effective rate was 91.4%. The cause of bleeding in 128 cases patients were：drug in 38 cases （29.9%） ,alcohol in 36 cases（28.1% ） ,fatigue in 20 Cases（ 15.6% ） ,mental stress in 21 cases（ 16.4% ） ,the incentive unknown in 13 cases（ 10.2% ）. Conclusion Clear the cause of bleeding in patients with cirrhotic portal hypertension and upper gastrointestinal bleeding. Explore the bleeding incentives. Proton pump inhibitor（PPI） formulations is suitable for the treatment of patient with peptic ulcer bleeding. Interventional treatment is suitable for cirrhotic portal hypertension. Somatostatin and its derivatives help reducing portal pressure, suitable for the treatment of esophageal and gastric varicose variceal bleeding.