肝硬化不同病因上消化道出血患者的临床对比

The clinical comparison of cirrhosis patients with different etiological upper digestive tract hemorrhage

目的比较肝硬化食管静脉曲张破裂出血和肝硬化非食管静脉曲张破裂出血患者的临床特征。方法选择2007年1月至2014年8月接受治疗的肝硬化合并上消化道出血患者300例。根据患者的出血原因,分为食管静脉曲张破裂出血(EVB)组182例,非静脉曲张破裂出血(NEVB)组118例。比较两组患者的临床表现、并发症情况和Child-Pugh肝功能分级。结果 EVB组患者呕血、呕吐咖啡样物的比率明显低于NEVB组,差异具有统计学意义(P>0.05)。EVB组患者失血性休克、便血的比率低于NEVB组,但差异无统计学意义(P<0.05)。EVB组患者出现肝癌、肝性脑病并发症的发病率低于NVEB组,门静脉血栓的发病率高于NEVB组,但差异无统计学意义(P>0.05)。EVB组患者Child-Pugh分级为A、B级的患者比率高于NEVB组,C级患者比率低于NEVB组,但差异无统计学意义(P>0.05)。结论肝硬化非静脉曲张破裂出血在肝硬化合并上消化道出血中并非罕见,EVB和NEVB患者的临床表现相似,但NEVB患者更易呕吐咖啡样胃内容物,可根据临床表现区分。

Objective To compare the clinical features of liver cirrhosis patients with esophageal variceal bleeding（ EVB）with liver cir-rhosis patients without EVB（ non-EVB,NENB）. Methods Three hundred liver cirrhosis patients with upper gastrointestinal hemorrhage trea-ted in our hospital between January 2007 and August 2014 were selected. The patients were divided into EVB group（n=182）and NEVB group （n=118）. Clinical manifestations,complications,and the Child-Pugh classification of liver function were compared between two groups. Re-sults The incidences of hematemesis and coffee-ground vomitus in EVB group were significantly lower than NEVB group（ P 〈0. 05）. The in-cidences of hemorrhagic shock,bloody stool,liver cancer,and hepatic encephalopathy were lower,and portal vein thrombosis incidence was high-er in EVB group,but no significant differences were found between two groups（ P 〉0. 05）. Child-Pugh classification of the patients showed that higher percentage of Child-Pugh class A and B,and lower percentage of Child-Pugh class C in EVB group than NEVB group,but the differences were not statistically significant between two groups（ P 〉0. 05）. Conclusion Clinical manifestations especially coffee-ground vom-itus may be used for the differentiation of EVB and NEVB.