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动态血压心电监测在食管静脉破裂出血抢救中意义
作者:曹耀军 郑以山 钟正江 
单位:中国人民解放军第81医院,急诊科,江苏,南京,210002
关键词:肝硬化/并发症 食管和胃静脉曲张/并发症 胃肠出血 血液动力学过程 超声检查 多普勒 彩色 
分类号:R571.3, R573.2
出版年·卷·期(页码):2005·24·第四期(256-258)
摘要:

目的:探讨动态血压心电监测在肝硬化食管静脉破裂出血抢救中的意义.方法:对40例肝硬化食管静脉破裂出血抢救成功患者进行回顾性对照研究,在治疗过程中均采用了心电监护仪动态监测患者的血压、心率、心电图,彩色多普勒超声仪(彩超)检测其门静脉系统血流动力学的变化,并监测肝、肾功能情况,分析比较血压高于110/70 mmHg组(A组),低于90/60mmHg组(B组)及血压在100~110/60~70mmHg组(C组)肝、肾功能损害,再出血百分率以及出血停止时间的变化.结果:A组再出血率明显升高,B组心、肝、肾功能损害发生率明显增高且出血停止时间长,C组再出血、脏器损害发生率均较低,差异有显著性意义(P<0.05).门静脉内径>1.4 cm,A组再出血发生率较其他两组高(P<0.05).结论:动态血压心电及彩超监测在肝硬化食管静脉破裂出血抢救中有一定的应用价值,值得进一步研究和推广.

Objective To explore the clinic significance of hemodynamically monitoring blood pressure in patients with hepatocirrhosis of variceal bleeding. [WTHZ]Methods [WT]The successful emergent treatment on 40 patients with hemorrhage from esophageal varices of hepatocirrhosis was retrospectively studied. Blood pressure(BP),heart electrocardiogram(ECG) were dynamically monitored. Using colour ultrasonagraphy the hemodynamic changes of portal system were detected and the liver,renal function were monitored. The damange of the liver ,renal function, the percentage of secondary bleeding and the clotting time were compared among three groups divided according to the blood pressure:>110/70 mmHg, <90/60 mmHg, 100~110/ 60~70 mmHg. Results [WT]In the group of blood pressure over 110/70 mmHg, the percentage of secondary bleeding was obviously high. In the group of BP below 90/60 mmHg, the damages of cardiac,liver and renal function were significant and clotting time was longer. In the group of 100~110/60~70 mmHg, the percentage of rebleeding and damage of organs were lower. The difference was significant(P<0.05). Conclusion [WT]Dynamical monitor of hemorrhage from esophageal varices of hepatocirrhosis has applicating value and waits to be further farther studied and widely spread.

参考文献:

[1] 施文娟, 张顺财. 奥曲肽和垂体后叶素治疗食管静脉破裂出血. 中国临床医学2000(2). doi:10.3969/j.issn.1008-6358.2000.02.036
[2] 陈灏珠. 实用内科学, 2001
[3] 关景明, 杜亚菊, 吕志诚. 食管静脉曲张破裂出血影响因素分析, 1998
[4] 李启诚, 何善寿, 熊上中. 近期上消化道出血高危因素的临床预测. 广西医学2001(4). doi:10.3969/j.issn.0253-4304.2001.04.047
[5] 王玲, 姜凡, 许建明. 超声对预测食管静脉破裂出血的价值与食管静脉测压对照分析. 安徽医学2001(3). doi:10.3969/j.issn.1000-0399.2001.03.006 

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