内镜下套扎治疗食管静脉曲张术后早、晚期再出血的原因分析及处理

Cause of early and late rebleeding after endoscopic variceal ligation and the nursing

目的分析内镜下套扎治疗食管静脉曲张术后早、晚期再出血的原因,总结预防再次出血的经验。方法 112例食管静脉曲张患者在内镜下予静脉曲张套扎术(EVL),随访近、远期出现33例复发出血的原因。结果 近期有13例于术后11 d内发生再出血(出血量均在800 mL以上),可能原因:饮食不当(进食粗糙、过硬食物或饱餐等)46.2%,腹压过高(排便用力、剧烈恶心或频繁呃逆)23.1%,全身营养状况不良15.4%,情绪紧张7.7%,诱因不明7.7%。共110例随访6个月以上,2例失访。6个月至60个月随访中出现上消化道出血20例,共22例次,可能原因主要有肝功能失代偿加重、不愿或不方便复查、感染及原因不明。结论应注重该类患者的整体护理,强调患者和家属在后续过程中配合的重要性。应建立随访机制,可更好的指导患者,达到预防出血的目的 。

【Objective】To analyze the cause of early and late rebleeding after endoscopic variceal ligation,and summarize prevention of rebleeding experience.【Methods】112 patients with endoscopic esophageal variceal ligation were followed-up.The causes of early and late rebleeding in 33 cases were collected.【Results】There were 13 cases rebleeding within 11 days postoperative,the possible causes were poor diet（eating rough,excellent food or meal） accounted for 46.2%,high abdominal pressure（defecation,severe nausea,frequent hiccups） 23.1%,poor nutritional status 15.4%,nervous 7.7%,and unknown incentives 7.7%.110 patients were followed up for more than 6 months,2 cases were lost.In the 6 months to 60 months of follow-up,there were 20 cases of upper gastrointestinal bleeding,a total of 22 cases.Maybe the main reason were decompensated liver function aggravation,unwilling or inconvenient review,infection and unexplained cause.【Conclusion】We should pay attention to such patients overall care,and emphasize the importance of patients and their families in the subsequent treatment process.Follow-up mechanism should be established,it can better guide the patient to achieve the purpose of prevention of bleeding.