肝硬化上消化道出血的时间分布与肝功能的关系

UPPER GASTROINTESTINAL BLEEDING IN VARIOUS SHIFT IN CIRRHOTIC PATIENTS AND CORRELATES WITH SEVERITY OF LIVER DISEASE

目的 :肝硬化门脉压力波动失去了正常的生理节律 ,在夜间逐渐增高并于 2 4 :0 0达到最高 ,该研究探讨门脉高压所致的食管胃底曲张静脉破裂与门脉高压性胃病出血的时间分布特点及其与肝功能的关系。方法 :对该院 1998～ 2 0 0 1年肝硬化上消化道出血的 136例住院病例进行回顾性分析 ,统计内镜确诊食管胃底曲张静脉破裂和门脉高压性胃病所致出血的次数 ,分析不同病因和Child -Pugh分级与不同的时段B1(19:0 0～ 2 4 :0 0 ) ,B2 (2 4 :0 0～ 9:0 0 )和B3(9:0 0～ 19:0 0 )出血的次数的关系 ,出血时间定义为出现呕血或黑便的时间 ,不同时段率的比较采用 χ2 检验。结果 :共有 198次上消化道出血胃镜证实因食管胃底曲张静脉破裂或门脉高压性胃病引起 ,其中 135 (6 8.2 % )次表现为呕血 ,6 3(31.8% )次表现为黑便 ,两者有显著性差异 (P <0 .0 1)。其中B1时段为 110 (5 5 .6 % )次 ,B2时段为 5 2 (2 6 .3% )次 ,B3时段为 36 (18.2 % )次 ,B1时段出血次数显著多于B2和B3时段 (P <0 .0 1) ,31(2 2 .8% )例ChildA级患者出血 4 0 (2 0 .2 % )次 ,5 2 (38.2 % )例ChildB级患者出血 6 6 (33.3% )次 ,5 3(39.0 % )例ChildC级患者出血 92 (46 .5 % )次 ,B1时段ChildC级出血 6 0 (5 4 .5 % )次 ,与ChildA ,ChildB级相比 ,

Objective:The portal pressure in cirrhotic patients loses the normal circadian variation and increase in night and got a maximum at midnight. This study were to evaluate the frequency of upper gastrointestinal bleeding from esophageal/gastric varices or portal congestive gastropathy during various shift and to correlate the frequency of bleeding during various shift with severity of liver disease. Methods:From 1998 to 2001, episodes of bleeding due to portal hypettension (PH), i.e., esophageal varices, gastric varices or congestive gasttopathy were noted.The time of occurrence of bleeding from PH in various shift, e.g.,B1 shift(19: 00～24: 00), B2 shift(24: 00～9: 00) or B3 shift (9: 00～19: 00) was determined. The severity ofliver disease was classified as A, B or C according to Child's classificatioo.Results:There were 198 episodes of upper gastrointestinal bleeding due to PH in 136 patients. 68.2% of patients presented with hematemesis, whereas 31.8% presented with melena ( P < 0.01). Bleeding started during the B1 shift in 110/198(55.6%), during the B2 shift in 52/198 (26.3%), and during the B3 shift in 36/198 (18.2%).There were 31(22.8%) patients in Child's A, 52 (38.2%) in Child's B, and 53 (39.0%) in Child's C.Among the 110 bleeders during B1 shift, 60 (54.5%) were in category C. It seems that m these patients upper gastrointestinal bleeding is more frequent during the B1 shift compared to B2 and B3 shift ( P < 0.01). Child's C patients are more likely to bleed during B1 shift compared to Child's A or B patients ( P < 0.01).Conclusion:The majority of the cirrhotic patients with PH who develop gastrointestinal bleedling present with hematemesis, The bleeding in these patients ,especially in category C is more likely to occur during the evening shift.