肝硬化食管静脉曲张出血患者的分期护理

对38例肝硬化食管静脉曲张患者行常规治疗的同时分期进行心理、认知行为、饮食、生活等护理干预。结果止血成功率迭89．5％。1年内再出血率下降。提示分期护理干预对肝硬化并食管静脉曲张出血患者作用明显。     

肝硬化食管静脉曲张出血患者的分期护理

对38例肝硬化食管静脉曲张患者行常规治疗的同时分期进行心理、认知行为、饮食、生活等护理干预.结果止血成功率达89.5%,1年内再出血率下降.提示分期护理干预对肝硬化并食管静脉曲张出血患者作用明显.     

食管镜下套扎对肝硬化食管静脉曲张的疗效观察

探讨食管镜下套扎术(EVL)治疗肝硬化食管静脉曲张的效果。以2013年1月—2014年1月接受治疗的肝硬化食管静脉曲张患者为观察对象。根据其治疗方式分为食管镜下套扎治疗组(EVL组)和食管镜下硬化剂注射治疗组(EIS组)。观察两组患者的治疗效果,比较两组患者治疗前后食管静脉曲张程度、出血率和并发症发生率的差异。EVL组治疗的有效率为94.74%,明显高于EIS组(78.12%),差异有统计学意义(P<0.05);治疗前两组患者食管静脉曲张程度分级差异无统计学意义(P>0.05),治疗后,EVL组静脉曲张程度较EIS组明显改善,差异有统计学意义(P<0.05);EVL组出血率较EIS组低(P<0.05),而两组患者胸痛、吞咽困难和发热发生率差异无统计学意义(P>0.05);两组患者治疗前生活质量得分差异无统计学意义(P>0.05),治疗后,两组患者生活质量均较治疗前增高,且EVL组增高更明显(P<0.05)。食管镜下EVL对肝硬化食管静脉曲张有较好的治疗效果,且并发症发生率低。     

经内镜食道静脉曲张套扎55例报告

本文报告运用食道静脉曲张套扎术（ＥＶＬ）５５例结果，发现ＥＶＬ对食道静脉曲张总有效率达１００％，急诊止血率８５．７％，且并发症少而轻。     

肝硬化门静脉高压食管静脉曲张出血的护理

目的探讨肝硬化门静脉高压食管静脉曲张出血的护理措施。方法总结分析38例门静脉高压食管静脉曲张出血患者的护理经验。结果治疗后患者门、脾静脉的内径减小、流速增快、门静脉血流量增加。38例患者24 h内出血停止29例,25～72 h内出血停止7例。结论肝硬化门静脉高压食管静脉曲张出血的有效护理可以让患者得到尽快恢复,提高生存质量。     

瑞马唑仑和丙泊酚用于肝硬化患者内镜下静脉曲张套扎术的比较

目的 探讨瑞马唑仑和丙泊酚对肝硬化患者内镜下静脉曲张套扎术血流动力学和不良反应的影响。
方法 纳入拟行内镜下静脉曲张套扎术的肝硬化患者96例,男43例,女53例,年龄18～70岁,BMI 18.5～27.9 kg/m²,ASA Ⅱ或Ⅲ级。采用随机数字表法将患者分为两组：瑞马唑仑组（R组）和丙泊酚组（P组）,每组48例。R组静脉注射瑞马唑仑0.2 mg/kg行麻醉诱导,静脉泵注瑞马唑仑1～2 mg·kg^-1·h^-1行麻醉维持;P组静脉注射丙泊酚2 mg/kg行麻醉诱导,静脉泵注丙泊酚4～10 mg·kg^-1·h^-1行麻醉维持。记录麻醉诱导前（T₀）、麻醉诱导后（T₁）、气管插管后（T₂）、手术开始后5 min（T₃）、拔管后（T₄）的HR和MAP。记录患者意识消失时间、拔管时间、意识恢复时间、PACU停留时间。记录术前、术后1 d谷氨酸-丙酮酸转氨酶（ALT）、天门冬氨酸氨基转移酶（AST）。记录术中低血压、术后低氧血症、头晕、恶心呕吐、苏醒延迟、苏醒期躁动的发生情况。
结果 与P组比较,R组T₁—T₃时HR、MAP明显升高（P＜0.05）,意识消失时间明显延长（P＜0.05）,拔管时间、意识恢复时间和PACU停留时间明显缩短（P＜0.05）,术中低血压、术后低氧血症发生率明显降低（P＜0.05）。两组T₀、T₄时HR、MAP差异无统计学意义。两组术后1 d ALT、AST和头晕、恶心呕吐、苏醒延迟、苏醒期躁动发生率差异均无统计学意义。
结论 与丙泊酚比较,瑞马唑仑对行内镜下静脉曲张套扎术肝硬化患者的血流动力学影响较小,可明显降低低血压发生率,安全性较高。     

内窥镜食管静脉曲张结扎术的护理

内窥镜食管静脉曲张结扎术是一种崭新的治疗方法，作者总结了对７８例肝硬化门脉高压食管静脉曲张的患者在实施食管静脉曲张结扎治疗后的护理措施，强调结扎术前予以镇静，让患者顺利地配合操作；术中用口咽外套管，用抽吸器油净胃内或食管内积血，以保证术野清晰，既有利于手术顺利进行，同时又可防止患者误吸。术后密切观察生命体征及症状的变化，防止因剧烈呕吐或咳嗽使结扎圈脱落出血。短暂的禁食既可防止结扎圈脱落，又能使患者     

内镜套扎术与硬化剂治疗食管及胃底静脉曲张

目的:探讨内镜套扎术与硬化剂治疗食管及胃底静脉曲张的疗效及并发症。方法:用多环结扎器进行内镜下套扎术治疗食管静脉曲张30例,其中14例合并胃底静脉曲张者应用硬化剂治疗。结果:全组30例患者,食管静脉曲张消失或基本消失22例;合并胃底静脉曲张14例,胃底静脉曲张消失或基本消失8例。随访26例,4例出现大出血。结论:内镜套扎术联合硬化剂治疗食管胃底静脉曲张是安全有效、切实可行的,是预防其破裂出血积极有效的措施。     

青海地区肝硬化食管胃静脉曲张破裂出血患者的延续护理

目的探讨延续护理对青海地区肝硬化食管胃静脉曲张破裂出血患者自我管理行为的影响。方法将住院治疗的370例肝硬化食管胃静脉曲张破裂出血患者按随机数字法分为对照组186例和干预组184例。对照组实施常规护理、健康教育及出院随访,干预组在常规护理基础上,应用肝病档案管理手册、规范随访等方式实施延续护理。出院后1年比较两组患者自我管理行为、再出血率、复查依从率。结果干预组自我管理行为评分显著高于对照组,再出血发生率显著低于对照组,而复查依从率显著高于对照组(均P0.01)。结论延续护理可提高肝硬化食管胃静脉曲张破裂出血患者自我管理行为,提高患者复查依从性,减少再出血,改善患者的生活质量。     

内镜下氰基丙烯酸酯注射法与套扎法治疗胃底食管静脉曲张的Meta分析

目的 对于食管胃底静脉曲张,目前国际上经典方法为套扎法,随着组织胶水被广泛应用临床,氰基丙烯酸酯被较多用在内镜下该病的硬化治疗.本文旨在对比两者在治疗食管胃底静脉曲张的优劣.方法 通过数据统计、定性分析、异质性分析、Meta分析,偏倚分析对已获得文献进行分析.结果 两组间急性出血止血率、根治率和死亡率差异无统计学意义,再出血率套扎组高于胶水组,食管静脉曲张组并发症胶水组高于套扎组.结论 氰基丙烯酸酯注射法和套扎法是治疗胃食管静脉曲张的有效方法.治疗胃底静脉曲张时注射法较套扎法再出血率低而并发症发生率相似,所以首选注射法.治疗食管静脉曲张时对于复发倾向较高的患者,在权衡并发症的情况下可以考虑使用注射法.     

Prognostic blue varices as a discriminant factor of variceal hemorrhage: Amendment of the criteria of endoscopic findings of esophageal varices

Up until now, the endoscopic findings related to hemorrhage from esophageal varices have been red color signs (RCS) and the fundamental bluish color (Cb) of the varices. Although most investigators agree with the former, there is considerable dispute regarding the latter “blue varices”. In order to identify the “risky” type of blue varices, prognostic varices (P-Cb) were specifically defined as being featured by a fully expanded appearance with a glossy surface, like an over-inflated balloon. Three hundred and nineteen collected patients with esophageal varices, including 114 bleeders, were retrospectively assessed and the P-Cb was found to have a significant correlation to the bleeding history. The P-Cb should be taken into account when attempting to predict bleeding of blue varices. The general rules for recording endoscopic findings of esophageal varices, as determined in 1980, should thus be amended. The Co-Operative Study Group included: Director, Kiyoshi Inokuchi, MD; members, Kaichi Isono, MD (Chiba Univ), Seiichiro Kobayashi, MD (Tokyo Women’s Med Coll), Ken Morita, MD (Nippon Univ), Terukazu Muto, MD (Niigata Univ), Fusahiro Nagao, MD (Jikei Med Coll), Keizo Sugimachi, MD (Kyushu Univ) and Mitsuo Sugiura, MD (Juntendo Univ)     

多元化护理在糖尿病感染患者护理中的应用

目的：探讨多元化护理在糖尿病感染患者护理中的应用。方法选择我院2009年1月～2014年1月收治的90例糖尿病并发感染的患者，按入院时间分为对照组45例和研究组45例，两组患者均采用常规护理方法，研究组在此基础上采用多元化护理，比较两组患者护理后感染改善情况。结果经多元化护理后研究组患者感染率较对照组明显减低，两组差异均具有统计学意义（P＜0.05）。结论多元化护理措施可降低糖尿病患者医院感染的发生率，提高患者生存质量。     

Transabdominal mucosal transection of the esophagus for the treatment of esophageal varices

Transabdominal mucosal transection of the esophagus was applied to 20 patients with esophageal varices. The operative procedure involves a longitudinal incision of the muscular layers which follows transection and reanastomosis of the denuded mucosa. With the preservation the muscular structure, postoperative complications such as anastomotic leakage, stenosis or regurgitation, have been minimized. The effect of this procedure on the varices proved satisfactory.     

A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices

Background: Endoscopic ligation (EVL) and endoscopic sclerotherapy (EIS) are both effective in the treatment of bleeding esophageal varices, but the efficacy of the two techniques in the prophylaxis of first variceal bleeding has not been investigated. The aim of this study was to investigate the frequency of first variceal bleeding, the recurrence of varices, and survival after treatment with the two techniques, as compared to a nontreated control group. Methods: A total of 157 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal bleeding were randomly assigned to either an EIS group (n= 55), an EVL group (n= 52), or a nontreated control group (n= 50). After the eradication of esophageal varices in the EIS and in EVL groups and in all control patients, the endoscopic examination was performed at 3-month intervals. Results: There were no significant differences between EIS and EVL in the eradication rate of esophageal varices (85% in the EIS group versus 81% in the EVL group). The mean number of sessions required to obtain eradication was lower in the EVL group than in the EIS group (4.8 ± 1.8 versus 6.2 ± 2.0; p= 0.0003), but the recurrence of esophageal varices was higher in the EVL group (31% versus 11%; p= 0.01). Total mortality was significantly lower in the EIS patients than in the controls (20% versus 38%; p= 0.04). It was also lower, but not significantly, in the EVL patients than in the controls (23% versus 38%; p= 0.10). A significant decrease in variceal bleeding was observed both in sclerotherapy cases (20%) and controls (54%; p= 0.0005) and in ligation cases and controls (29%; p= 0.01). No significant difference in bleeding episodes was observed between the sclerotherapy and ligation cases (p= 0.29). No serious complications were observed either in the EIS or EVL groups. Conclusions: EIS and EVL are similarly effective in the prevention of first variceal bleeding. The choice between EIS and EVL depends on the skill of the endoscopic unit. For highly experienced surgeons facing no complications, sclerotherapy seems to be preferable; for all others, it is technically easier to perform ligation. Received: 29 June 1998/Accepted: 18 September 1998     

剪切波弹性成像对食管静脉曲张的诊断价值

目的探讨剪切波弹性成像技术(SWE)对食管静脉曲张(EV)严重程度和破裂出血的诊断价值。方法对临床确诊的103例肝硬化患者行超声、内镜及实验室检查,分析性别、年龄、体质量指数(BMI)、肝功能Child-Pugh分级、肝硬度(LS)、LS×脾长径与血小板(PLT)比值指数(LSPS)、血小板与天冬氨酸氨基转移酶比值指数(APRI)、脾硬度(SS)对有无EV、低危和高危EV、有无EV破裂出血的预测价值,并进行相关性分析。结果有EV与无EV肝硬化患者之间,Child-Pugh分级、LSPS、APRI、LS、SS差异均有统计学意义(P均0.05),LS、SS是诊断EV的独立影响因素。LSPS、APRI、LS、SS诊断EV的AUC为0.84、0.79、0.83和0.89。低危和高危EV患者Child-Pugh分级、LS、SS差异有统计学意义(P均0.05);有无EV破裂出血患者SS差异有统计学意义(P0.01),SS为预测高危EV及有无EV破裂出血的独立影响因素。有无EV与Child-Pugh分级相关性较弱(r=0.35,P0.05),与LSPS、APRI、LS相关性中等(r=0.52、0.45、0.51,P均0.05),与SS相关性较强(r=0.61,P0.05)。结论 SWE对肝硬化患者EV严重程度和破裂出血有较高价值,可作为预测EV分级和破裂出血的无创检查技术。SS对EV的诊断价值高于LS。     

Endoscopic resection of carcinoma in situ of the esophagus accompanied by esophageal varices

Summary A case of carcinoma in situ of the esophagus accompanied by esophageal varices was treated by endoscopic mucosal resection using a transparent tube (EMRT) following eradication of the varices via injection sclerotherapy (EIS). Intravariceal injection sclerotherapy was performed for esophageal varices, and after eradication of the varices had been achieved, half of the circumferential esophageal mucosal resection of the cancer lesion was carried out. No serious complication such as perforation or mass bleeding was observed. Cancer-involved mucosa was completely resected and all specimens contributed well to accurate histopathological study, being diagnosed as intraepithelial squamous-cell carcinoma. The artificial ulcer recovered completely, showing no stenotic changes. Our conclusion from this experience is that EIS + EMRT is a valuable and minimally invasive treatment for patients exhibiting this disease, providing an accurate histopathological diagnosis.     

Development of erosive gastritis in a canine model of esophageal varices

We designed a reproducible canine model of esophageal varices, based on the concept of a regional hyperdynamic state in the upper stomach. Arterialization of the left gastric vein concomitant with the distal splenorenal shunt led to a stable hyperdynamic state and reproducible esophageal varices occurred. In the long-term follow-up of these dogs with varices, the erosive gastritis seen in the upper stomach learly resembled clinically observed lesions. Hemodynamic and morphological studies revealed that gastric mucosa of these animals was in an ischemic state, even though there was a remarkable increase in blood flow in the submucosal area. It is suggested that the decrease in mucosal blood flow, as induced by the hyperdynamic state caused erosive gastritis.     

Endoscope assisted surgery for the treatment of bleeding esophageal varices

In attempts to obtain complete control of bleeding esophageal varices, terminal esophago-proximal gastrectomy (TEPG) and its modification proximal gastric transection (PGT) were performed, under endoscopic assistance, in 42 patients with cirrhotic portal hypertension. Complete disappearance of varices was confirmed in all patients at surgery and 4 weeks after surgery, and this condition was maintained for up to 60 months in 15 patients of TEPG and 16 of PGT. Recurrent varices in 3 (17 per cent) TEPG and 8 (34 per cent) PGT were attributed to the advance in the liver cirrhosis in 7, hepatoma in 3 and portal vein thrombosis in 1. In 8 of 11 recurrences, type C variceal blood circulation drained into the cervical veins. Endoscopic assistance during surgical treatment for bleeding esophageal varices plays a decisive role.     

Esophageal transection may well be the approach of choice for patients with portal venous obstruction and esophageal varices

Thirty patients with esophageal varices, portal venous obstruction and a histologically proven normal liver underwent either one of 2 different types of surgery. Shunt surgery was performed on 20 patients: 9 had a mesocaval shunt, 3, a splenorenal shunt, 4, a left gastric venacaval shunt, and 4, a distal splenorenal shunt. Conversely, direct interruption was performed on the other 10 patients: 6 underwent an esophageal transection, and 4 underwent a resection of the proximal stomach. Re-hemorrhage occurred in 7 of the former 20 patients but not in any of the 10 on whom the direct interruption method was used. In 6 of these 7 patients who experienced rebleeding, subsequent direct interruption surgery led to control of the bleeding. One patient died of a variceal hemorrhage one month postoperatively. The total 10 year cumulative survival rate was 86.3 per cent. In the light of these findings, we believe that methods of direct interruption, such as esophageal transection, may well be the approach of choice for patients with esophageal varices caused by extrahepatic portal venous obstruction.