目的:研究Child-Pugh分級對失代償期肝硬化預后的預測價值。方法:對34例死于失代償期肝硬化患者進行回顧性分析,應用Child-Pugh分級對初次入院資料進行評分及分級,并計算初次入院至死亡的時間。結果:Child-Pugh分級A級生存時間56.2±24.7月、B級33.1±10.5月、C級12.6±9.6月;以上消化道出血為主要表現的患者,生存時間相對非出血者低(Plt;0.05)。結論:Child-Pugh分級可做為預測失代償期肝硬化患者的生存時間的重要的客觀指標。而是否伴有上消化道出血對生存時間有較大的影響;上腹部增強CT對失代償期肝硬化患者有無肝腎分流等側支循環的評估有助于出血風險的判斷。
目的 探討肝硬化并發肝性胸水的臨床特點、發生機制及治療。 方法 回顧分析2006年3月-2009年3月收治的49例肝硬化并發肝性胸水患者的臨床資料。 結果 肝性胸水的發生率為18.9%，多見于右側（71.4%）。胸水性質多為漏出液（81.6%），但滲出液亦不少見（18.4%）。門脈高壓和低蛋白血癥是肝性胸水發生的重要原因。 結論 臨床上肝硬化并發胸水并不少見，應高度重視，采取多種綜合治療方法可提高療效。
【摘要】 目的 應用門冬氨酸鳥氨酸對肝性腦病的臨床療效及安全性進行觀察。 方法 2000年4月-2009年11月，將60例肝硬化肝性腦病患者分為對照組和治療組，對照組給予常規精氨酸治療，治療組在對照組基礎上加門冬氨酸鳥氨酸10 g/d，靜脈滴注，連續7 d。觀察治療前后神志變化、血清氨基轉移酶(ALT、AST)、血清白蛋白(ALB)等指標變化。 結果 治療組經門冬氨酸鳥氨酸治療后神志改變、ALT、AST明顯優于治療前（Plt;0.05）。 結論 門冬氨酸鳥氨酸治療肝性腦病療效確切，且對肝功能有改善作用，副反應小。【Abstract】 Objective To evaluate the clinical efficacy and safety of L-ornithine-L-aspartate treating the patients with hepatic encephalopathy. Methods Sixty patients with hepatic encephalopathy from April 2000 to November 2009 were randomly divided into treatment group and control group with 30 patients in each. The patients in the control group were treated with the routine therapy of arginine, while the ones in the treatment group were treated with L-ornithine-L-aspartate besides the routine therapy for one week injection (10.0 g dissolved in 5% glucose 250 mL by intravenous infusion once daily), the liver function and mind change were observed in all patients at the onset and one week after treatment respectively. Results One week after the treatment, the liver function (ALT, AST) and mind change of patients differed statistically significantly from that before the treatment (Plt;0.05). Conclusion L-ornithine-L-aspartate is effective for the patients with minimal hepatic encephalopathy, which could improve the liver function with little side effect.
Objective To investigate the mediating effect of nursing intervention of sleep hygiene on insomnia in patients with liver cirrhosis. Methods One hundred and eighteen cirrhotic patients with grade-A liver function and insomnia treated between June 2012 and January 2015 were divided into control group (n=52) and intervention group (n=66) with random number table method. The control group received conventional nursing only, while the intervention group was given nursing intervention of sleep hygiene. The sleep quality of patients in the two groups on admission and discharge were surveyed and compared based on Pittsburgh sleep quality index (PSQI). The nursing effect was also compared between the two groups on discharge. Results There was no statistically significant difference in total score and scores for each factor of PSQI between the two groups of patients on admission (P>0.05). However, the total score and scores for each factor of PSQI on discharge in both groups were significantly lower than those on admission (P<0.05). Besides, the scores in the intervention group were significantly lower than those in the control group (P<0.05). The effect of nursing in the intervention group was superior to that in the control group (P<0.001). Conclusions Nursing intervention of sleep hygiene can effectively improve sleep quality in cirrhotic patients with grade-A liver function. The role of nursing intervention in the treatment of insomnia should be taken seriously.
ObjectiveTo summarize experience of laparoscopy combined with choledochoscopy common bile duct exploration for patients with schistosomiasis liver cirrhosis with common bile duct stones. MethodThe clinical data of 45 patients with schistosomiasis liver cirrhosis combined with common bile duct stones (liver function Child-Pugh grade A and B) admitted in this hospital from September 2012 to September 2015 were analyzed retrospectively. ResultsTwenty cases were successfully treated by laparoscopy combined with choledochoscopy (laparoscope group), 25 cases were treated by conventional open common bile duct exploration (laparotomy group). Two cases were converted to laparotomy due to bleeding during laparoscopic operation. The mean operation time, intraoperative bleeding, postopera-tive hospitalization time, and postoperative total complications rate had no significant differences between these two groups (P>0.05). There were 2 cases of pulmonary infection and 1 case of incision infection in the laparoscope group, and 1 case of grade A bile leakage and 1 case of pulmonary infection in the laparotomy group, there was no common bile duct stone residual in these two groups. ConclusionAlthough laparoscopic surgery is more difficult for schistosomiasis liver cirrhosis combined with common bile duct stones patients, it is safe and feasible. Appropriate perioperative management and precise laparoscopic and choledochoscopic operation are key to success of operation.
ObjectiveTo provide references for postoperative analgesia treatment for cirrhotic patients with bone fracture. MethodsOne elderly patient with liver cirrhosis and fracture was admitted to our hospital on July 9, 2013. We obtained medical evidences by searching databases and regulated the best treatment after evaluating the patient's comprehensive conditions. And then, the whole treatment strategy was fully implemented. Finally, the consequent results were evaluated. ResultsWe identified 22 relevant articles including one clinical guideline, three cochrane reviews, five systematic reviews, seven small sample randomized controlled trials, one high quality observational study, and five quantitative reviews. We found that opioid analgesics utilization combined with non-opioid analgesics could not only reduce the occurrence of opioid drug adverse reactions, but increase analgesia safety. Cox-2 inhibitors could be used as the first choice of non-opioid drugs due to the less adverse reaction and better analgesic effectiveness. ConclusionFor femur fracture patients with liver cirrhosis, treatment decision based on evidence-based medicine is more scientific, which can ensure maximum benefit for the patients.
ObjectiveTo investigate impact of splenectomy plus pericardial devascularization on liver hemodynamics and liver function for liver cirrhosis patients with portal hypertension. MethodsThe internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of portal vein and hepatic artery of 42 cases of liver cirrhosis with portal hypertension were measured by Doppler ultrasonic instrument on day 1 before operation and on day 7 after operation. The free portal pressures at different phases (after open abdomen, after splenic artery ligation, after splenectomy, and after devasculanrization) were read from the disposable pressure sensor. Twenty-four healthy people through physical examination were selected as control. Results① The free portal pressure of liver cirrhosis patients with portal hypertension was decreased from (29.12±1.40) mm Hg after open abdomen to (22.71±1.21) mm Hg after splenic artery ligation, and further decreased to (21.32±1.12) mm Hg after splenectomy, but increased to (22.42±1.15) mm Hg after devasculanrization, the difference was statisticly different (all P < 0.01). ② Compared with the healthy people, for the liver cirrhosis patients with portal hypertension, the internal diameter, maximum velocity, minimum velocity, and flow volume of portal vein were significantly enlarged (all P < 0.01), which of hepatic artery were significantly reduced (all P < 0.01) on day 1 before operation; On day 7 after operation, the internal diameter of portal vein was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, and mean velocity of portal vein were significantly enlarged (all P < 0.01), but the internal diameter of hepatic artery was significantly reduced (P < 0.01), the maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01). For the liver cirrhosis patients with portal hypertension, compared with the values on day 1 before operation, the internal diameter and the flow volume of portal vein were significantly reduced (all P < 0.01) on day 7 after operation; the internal diameter, maximum velocity, minimum velocity, mean velocity, and flow volume of hepatic artery were significantly enlarged (all P < 0.01) on day 7 after operation. ③ The Child-Pugh classification of liver function between before and after surgery had no significant difference (χ2=1.050, P > 0.05). ④ No death and no hepatic encephalopathy occurred, no thrombosis of splenic vein or portal vein was observed on day 7 after surgery. Conclusionsplenectomy plus pericardial devascularization could decrease portal vein pressure and reduce blood flow of portal vein, while increase blood flow of hepatic artery, it doesn't affect liver function.
目的:為了探討肝硬化放腹水后應用右旋糖酐40代替人血白蛋白治療頑固性腹水的臨床療效及其經濟性。方法:將216例肝硬化頑固性腹水患者隨機分為A,B,C三組。A組:定期放腹水后應用右旋糖酐40;B組:定期放腹水后應用人血白蛋白或血漿;C組:傳統治療方法,限鈉和不斷增加利尿劑用量。結果:A組分別與B組,C組相比較,其腹水消退時間,ALT復常率,輸血不良反應,住院費用,平均住院日,好轉治愈率,死亡率,以上各項對比均有顯著性差異(Plt;0.05)。血清蛋白量的對比無顯著性差異(Pgt;0.05)。結論:肝硬化放腹水后應用右旋糖酐40治療頑固性腹水,能縮短病程,減少住院日,降低醫療費用,降低死亡率。
ObjectiveTo discuss the clinical characteristics of liver cirrhosis in elderly patients. MethodsWe retrospectively analyzed the clinical data of 67 patients (elderly group) with liver cirrhosis aged ≥60 treated between January 1998 and December 2010. Then, we compared these cases with another 72 liver cirrhosis patients (non-elderly group) aged<60. ResultsThe incidence of jaundice, ascites and albumin deficiency in the elderly patients was significantly higher than that in the non-elderly patients (P<0.05). Complications in the elderly group were relatively more, including electrolyte imbalance, infections, gastrointestinal bleeding, hepatic encephalopathy, liver cancer, liver and kidney syndrome and liver and lung syndrome, and the incidence of these complications was all significantly higher than the non-elderly group (P<0.05) except the liver and kidney syndrome (P>0.05). The causes of liver cirrhosis in both groups were similar. The most common cause was hepatitis B virus infection, followed by chronic alcoholism, but in the elderly group, chronic alcoholism, cholestasis, poisoning from medicines and poisons and liver blood circulation disorders were more common than the non-elderly group (P<0.05); hepatitis B and non-alcoholic fatty hepatitis were more common in the non-elderly group than in the elderly group (P<0.05). The elderly group had more Child-Pugh class C cases (P<0.05), while there were more class A cases in the non-elderly group (P<0.05). Twenty-six patients died in the elderly group with a mortality rate of 38.8%; while only 13 died in the non-elderly group with a mortality rate of 18.1%. The difference of mortality rate was significant between the two groups (P<0.05). Common causes of death in the elderly group were infection, hepatic encephalopathy, and electrolyte disorders and gastrointestinal bleeding, while the common causes of death in the non-elderly group were gastrointestinal bleeding and electrolyte disorders. ConclusionThe etiology, clinical manifestations and prognosis of liver cirrhosis in elderly patients differ from those in younger patients. We must pay more attention on treating complications of liver cirrhosis in elderly patients.