肝硬化合并食道静脉曲张破裂出血危险因素的研究

本研究目的在于探索导致肝硬化食道静脉出血的各种危险因素。病例来源于我院1983～1985年收治的部分门脉性肝硬化合并食道静脉曲张患者共100例,按其是否伴有食道静脉曲张出血分为出血组和非出血组各50例,对导致出血的各种危险因素进行了回顾性调查。最后本文提出了引起静脉曲张出血的始发危险因素是门脉高压的程度;门静脉游离压>3.49Kpo,或B超探测门静脉(总干)直径>1.9cm,脾静脉(脾门处)>1.3cm。促发因素;男性,年龄>40岁,合并肺部感染,脾功能亢进(血色素<70g/L,白细胞计数<5×10~9/L,血小板<60×10~9/L)。具备上述始发危险因素二项和促发危险因素二项以上的食道静脉曲张患者,提示出血高度可能性。建议用B型超声探测门静脉、脾静脉和肠系膜上静脉直径作为判断门静脉压的一种手段,可使肝硬化患者避免导管检测或食道镜检查带来的危险和不便。

A STUDY OF RISK FACTORS OF HTMORRHAGE FROM ESOPHAGEAL VARICES ASSOCIATED WITH PORTAL CIRRHOSIS OF THE LIVER

Risk factors causing hemorrhage from rupture of esophageal varices associated with portal cirrhosis of the liver were studied in 100 cases. The patients were devided into the hemorrhagieal and the nonhemorrhagical group each of which consisted of 50 cases. The paper concluded that the primary risk factors of hemorrhage consis of : the severity of the portal hypertension vein; the free portal pressure 3.49 kpa and certain evidences in B-mode ultrasonic echography: the transverse dimension of the main portal vein >1.9 cm, the spleenic vein (at the hilum) >1.3 cm. The precipating factors include : the malesex, age above 40 years, pulmonary infec tion, hypersplenism (hemoglobin<70g%, white blood cell count<5×10~9/L, platelete count<60×10~9/L) . The presence of two primary and two or more precipating factors means a possible hemorrhage. The author considered it advisable to perform a B-mode ultrasonic examention to measure the transverse dimension of the ain poital vein, splenic vein and upper naesenteric vein and estimate the portal pressure, This will avoid the risk brought about by the portal catheterization and esophagoscopy.