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Objective To assess the value of hepatic venous pressure gradient in the evaluation of early postoper﹣ative hemorrhage after endoscopic esophageal varices ligation (EVL). Methods 120 cases of rebleeding after EVL from January 2014 to January 2015 as subjects. Collect and study clinical indexes such as the venous pressure gra﹣dient, then used logistic regression analysis method to analyze the threshold assessment. Results Drinking, hemor﹣rhage in early stage, bilirubin, heart rate, blood transfusion, child Pugh score and MELD score were significant dif﹣ferences (P< 0.05); HVPG=16.98 mmHg, for the prediction of rebleeding threshold, and in the time of the highest predictive accuracy. Conclusion The hepatic venous pressure gradient has an accurate evaluation value for early postoperative hemorrhage after endoscopic esophageal varices ligation.
RESUMO
Objective To study the sedative and analgesic effects of different drugs on patients under-going endoscopic variceal ligation( EVL). Methods Sixty patients undergoing selective EVL were randomly assigned to three groups:pethidine group( A),propofol-fentanyl group( B)and dexmedetomidine-fentanyl group(C). Data concerning blood pressure,heart rate,peripheral oxygen saturation,Ramsay score,endo-scopic operation and anesthesia time,surgeons' satisfaction and adverse reactions were recorded. Follow-up was done 24 hours later to confirm the patients' satisfaction and incidence of intraoperative awareness. Results The Ramsay scores of group B(5. 2 ± 0. 3)and C(3. 5 ± 0. 4)were significantly higher than group A (1. 6 ± 0. 4)(P<0. 05). There was no cough,body movement and high blood pressure during the EVL in group B or C,while the incidences of these symptoms in group A(40%,40% and 30%)were obviously higher (P<0. 05). The surgeons'satisfaction of group B(9. 2 ± 0. 3)and C(9. 6 ± 0. 4)were significantly higher than that of group A(5. 0 ± 0. 4)(P<0. 05). The patients' satisfaction scores of group B(9. 6 ± 0. 3)and C (9. 6 ± 0. 4)were also markedly higher than that of group A(5. 4 ± 0. 3)(P<0. 05). There was no difference of operation time among the three groups. The anesthesia time of group A(44 ± 6)was obviously longer than those of group B(35 ± 4)and C(36 ± 5)(P<0. 05). There was no difference in patients'or surgeons'satis-faction,or anesthesia time between group B and C. But the incidences of bradycardia( 40%),hypotension(30%)and hyoxemia(30%)in group B were obviously higher than those of group C(5%,0,0)(P<0. 05). There was no intraoperative awareness in group B or C. Conclusion Both dexmedetomidine and propofol com-bined with fentanyl are superior to pethidine for patients undergoing EVL,while dexmedetomidine provides bet-ter hemodynamics and respiratory conditions compared with propofol.
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ObjectiveTo explore the effect of doctor-nurse integration mode in treating patients with liver cirrhosis treated with endoscopic variceal ligation (EVL).Methods According to the random number table,74 patients were randomly divided into control group and experiment group with 37 in each group.The control group was given routine nursing,while the experiment group was managed by doctor-nurse integration nursing mode.The two groups were compared in respect of early re-bleeding after EVL and mastery of health knowledge.Result The mastery of health-related knowledge in the experiment group was better than the control one and the rate of re-bleeding was significantly lower (P<0.05).Conclusion The doctor-nurse integration care mode can reduce the early postoperative re-bleeding after EVL in patients with liver cirrhosis and enhance the health education awareness.
RESUMO
52 patients (46 males, 6 females) with esophageal varices bleeding, age from 19-84 years, who were treated at the Central Military hospital 108 from September 2002 to September 2003. The level of breakdown via endoscopy and the number of esophageal varices breakdown on 52 patients included: 5 cases with mild level, 13 cases with average and 34 cases with severe level; 7 patients at grade II, 45 grade III; 59.6% of patients in the first time of bleeding, 21.6% secondly and 19.2% ≥3 times. Treatment results: 71.2% patients had a complete hemostasis; recurrent rate was 57.7%, in which the rate was 9.6% during first month. For 2 years of followed up, mortality rates one month and 2 years after were 13.3% of 57.7%, respectively. The results indicated that the endoscopic varices ligation have good effectiveness in urgent hemostatic cases but ineffectiveness in long-term outcome.