门-体分流术后并发肝性脑病的危险因素分析

Risk factor analysis of hepatic encephalopathy after portosystemic shunt

目的探讨门-体分流术后并发肝性脑病(HE)的危险因素。方法选取2013-12—2016-12平顶山市第一人民医院行门-体分流治疗的142例肝硬化门静脉高压症患者,依据其术后6个月内是否并发HE分为观察组(并发HE,n=31)与对照组(未并发HE,n=111),比较2组性别、肝硬化病因、年龄、肝功能Child-Pugh分级与血钠、血红蛋白(Hb)、血清纤维蛋白原(Fib)水平,分析术后并发肝性脑病的危险因素。结果 2组性别、肝硬化病因相比,差异无统计学意义(P>0.05),观察组年龄、肝功能Child-Pugh分级高于对照组,差异有统计学意义(P<0.05);观察组血钠、Hb、血清Fib水平低于对照组,差异有统计学意义(P<0.05);Logistic回归分析显示,患者肝功能Child-Pugh分级、年龄为其术后发生HE的独立危险因素,而血钠、Hb与血清Fib水平为其术后发生HE的重要保护因素(P<0.05)。结论肝功能Child-Pugh分级、年龄为门-体分流术后患者发生HE的独立危险因素,而血钠、Hb与血清Fib水平为保护因素。临床工作中应对HE高危患者施行针对性干预,以降低HE发病率,改善患者预后。

Objective To investigate the risk factors of hepatic encephalopathy(HE)after portosystemic shunt.MethodsTotally 142 patients with portal hypertension were treated with portosystemic shunt from December 2013 to December 2016 in our hospital.The patients were divided into the observation group(complicated HE,n=31)and the control group(not complicated HE,n=31)according to whether they were complicated by HE within 6 months after the operation or not.The gender,etiology,age,liver function,Child-Pugh grade,and serum sodium,hemoglobin(Hb)and serum fibrinogen(Fib)levels were compared between the two groups.Then analyze the risk factors of postoperative hepatic encephalopathy.Results The gender and cirrhosis etiology were compared between the two groups.The difference was not statistically significant(P>0.05).The age and liver function Child-Pugh grade of the observation group were higher than that of the control group,the difference was statistically significant(P<0.05).The levels of serum sodium,Hb and serum Fib in the observation group were lower than those in the control group,the difference was statistically significant(P<0.05).Logistic regression analysis showed that liver function Child-Pugh grade and age were independent risk factors of HE after operation.Serum sodium,Hb and serum Fib level were the important protective factors for HE after operation(P<0.05).Conclusion Child-Pugh grading and age of patients with liver function are independent risk factors for postoperative HE.Serum sodium,Hb and serum Fib level are important protective factors for HE after operation.In clinical practice,targeted intervention should be carried out in high-risk patients with HE after operation so as to reduce the incidence of HE and improve the prognosis of patients.