肝硬化合并上消化道大出血的基层医院诊治体会(附313例报告)

Experience of diagnosis and treatment of liver cirrhosis combined with upper gastrointestinal hemorrhage in primary hospital(A report of 313 cases)

目的:总结基层医院对肝硬化合并上消化道大出血的诊治经验。方法:对313例患者首先进行药物治疗,包括液体复苏、血管加压素及其类似物、生长抑素类似物、H2受体阻滞剂或质子泵抑制剂等,无效者置三腔两囊管,因基层医院无内镜、肝移植、介入等诊疗条件,置三腔两囊管无效者行贲门周围血管断流术。结果:药物治疗获止血285例,保守治疗止血效果不佳28例。其中合并肾功能不全、高血压病史各1例,因病情危重很快死亡。放置三腔二囊管治疗出血停止20例。急诊行贲门周围血管断流术6例,术后肝昏迷死亡2例,多器官功能衰竭死亡2例。腹水加重3例,新发腹水5例。肾功能不全加重1例。转氨酶较前升高7例。低血糖短暂昏迷1例。结论:药物治疗是曲张静脉破裂出血的首选治疗手段,但需注意止血与合并症之间的治疗矛盾、注意维护肝功能、防治低血糖、提升血压至适当水平。三腔二囊管压迫止血可用于药物治疗无效或作为其他治疗前的过渡。药物联合内镜治疗是目前治疗急性静脉曲张出血的主要方法之一,可提高止血成功率,但在基层医院不具备内镜治疗的条件下,使得药物治疗效果不佳的病例被迫选择了急诊外科手术,术后较多的并发症严重影响疾病的转归。

Objective:To summarize the experience of diagnosis and treatment of liver cirrhosis combined with upper gastrointestinal hemorrhage in primary hospital.Methods:313 patients using the drug treatment first,including fluid resuscitation,vasopressin analogues,somatostatin analogues,H2 receptor antagonists or proton pump inhibitors,invalid setting for three cavity two of cystic duct,for primary hospital without endoscopic,liver transplantation,like intervention condition,the three cavity two of cystic duct was invalid underwent pericardial devascularization.Results:Drug treatment was bleeding in 285 cases,poor in 28 cases of conservative treatment of hemostatic effect.The patients with renal insufficiency,hypertension 1 cases each,for critically ill soon die.Place the three cavity two treatment of cystic duct of stop bleeding in 20 cases.Emergency pericardial devascularization in 6 cases,postoperative hepatic coma died in 2 cases,2 patients died of multiple organ failure.ascites increased3,new onset ascites in 5 cases.Renal dysfunction aggravated in 1 cases.Comparing with the previous 7 patients with elevated transaminase.Transient hypoglycemia coma in 1 cases.Conclusion:Drug therapy is the treatment of choice for variceal bleeding,but it should pay attention to the bleeding and complications between treatment of contradiction,pay attention to the maintenance of liver function,prevention of hypoglycemia,improve blood pressure to the appropriate level.Three cavity two capsule tube compression hemostasis can be used as drug treatment is invalid or other treatment before the transition.Drugs combined with endoscopic therapy is currently one of the main methods for the treatment of acute variceal hemorrhage,it can improve the success rate of hemostasis,but the grass-roots hospital does not have the endoscopic treatment conditions,makes the treatment effect of poor drug cases were forced to choose the emergency surgery operation,it has higher postoperative complications,serious impact on the outcome of a disease.