急性食管胃底静脉曲张破裂出血行急诊经颈静脉肝内门体分流术后发生肝性脑病的危险因素分析

姚运海; 罗艳; 朱京乐; 甘建和; 赵卫峰

doi:10.3969/j.issn.1001-5256.2020.02.022

急性食管胃底静脉曲张破裂出血行急诊经颈静脉肝内门体分流术后发生肝性脑病的危险因素分析

DOI: 10.3969/j.issn.1001-5256.2020.02.022

1. 苏州大学附属第一医院感染科/肝病ICU
2. 湖南省妇幼保健院医务部

基金项目:

医学科学研究基金(YWJKJJHKJJ-g1706)；

详细信息

中图分类号: R575.2
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出版历程
- 收稿日期: 2019-09-18
- 出版日期: 2020-02-20

Risk factors for hepatic encephalopathy after emergency transjugular intrahepatic portosystemic shunt for patients with acute esophagogastric variceal bleeding

Department of Infectious Diseases/Intensive Care Unit of Hepatology,The First Hospital Affiliated of Soochow University

Research funding:

摘要

摘要:
目的通过临床结果分析了解急性食管胃底静脉曲张破裂出血行急诊经颈静脉肝内门体分流术（TIPS）术后肝性脑病（HE）的危险因素。方法回顾性分析2013年1月-2018年12月因失代偿期肝硬化伴急性食管胃底静脉曲张破裂出血在苏州大学附属第一医院接受内镜或者药物治疗失败,72 h内行覆膜支架TIPS治疗的93例患者的临床资料。根据术后发生HE情况分为HE组（n=36）和非HE组（n=57）。收集患者术前临床资料,包括性别、年龄、病因、合并症,血生化指标包括WBC、PLT、红细胞比积、TBil、AST、Alb、血清肌酐、PT等,根据实测值分别计算每位患者MELD评分,记录TIPS支架植入前测得的肝静脉锲压与游离压,肝静脉压力梯度（HVPG）为两者的差值。计量资料两组间比较采用t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验。二分类变量logistic回归分析TIPS术后患者的预后危险因素。结果术后HE发病率为38. 710%,两组间术前MELD评分[（13. 000±3. 189）分vs（11. 684±2. 068）分,t=2. 068,P=0. 043]、HVPG[（...
- 食管和胃静脉曲张 /
- 肝性脑病 /
- 危险因素
Abstract:
Objective To investigate the risk factors for hepatic encephalopathy( HE) after emergency transjugular intrahepatic portosystemic shunt( TIPS) for patients with acute esophagogastric variceal bleeding( EVB) based on an analysis of clinical outcomes. Methods A retrospective analysis was performed for the clinical data of 93 patients with decompensated liver cirrhosis and acute EVB who failed endoscopy or medication and then underwent TIPS with a covered stent within 72 hours in The First Affiliated Hospital of Soochow University from January 2013 to December 2018. According to the presence or absence of HE after surgery,they were divided into HE group with 36 patients and non-HE group with 57 patients. Preoperative clinical data were collected,including sex,age,etiology,comorbidities,and blood biochemical parameters [white blood cell count( WBC),platelet count( PLT),hematocrit( Hct),total bilirubin( TBil),aspartate aminotransferase( AST),albumin( Alb),serum creatinine( SCr),and prothrombin time( PT) ],and the measured values were used to calculate Model for End-Stage Liver Disease( MELD) score. Wedged hepatic venous pressure( WHVP) and free hepatic venous pressure( FHVP) were measured and recorded before TIPS stent implantation,and hepatic venous pressure gradient( HVPG) was the difference between WHVP and FHVP. The t-test or the Mann-Whitney U test was used for comparison between two groups,and the chi-square test was used for comparison of categorical data between two groups. A binary logistic regression analysis was used to identify the risk factors for the prognosis of patients after TIPS. Results The incidence rate of postoperative HE was 38. 710%. There were significant differences between the two groups in preoperative MELD score( 13. 000 ± 3. 189 vs 11. 684 ± 2. 068,t = 2. 068,P = 0. 043) and HVPG( 24. 908 ±5. 317 mm Hg vs 22. 597 ± 4. 928 mm Hg,t = 2. 100,P = 0. 039). Based on the results of HE grading,17 patients( 47. 222%) had grade0-1 HE,9( 25. 000%) had grade 2 HE,6( 16. 667%) had grade 3 HE,and 4( 11. 111%) had grade 4 HE. The stepwise logistic regression analysis showed that MELD score( odds ratio [OR]= 0. 803,95% confidence interval [CI]: 0. 679-0. 948,P = 0. 010) and HVPG( OR = 0. 896,95% CI: 0. 816-0. 984,P = 0. 022) were independent risk factors for HE after TIPS. Conclusion There is a high incidence rate of HE after emergency TIPS for acute EVB,and preoperative MELD score and HVPG can predict the risk of HE after TIPS.
- esophageal and gastric varices /
- hepatic encephalopathy /
- risk factors

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参考文献(25)

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