How does liver cirrhosis break bleed dangerously to predict _'s prevention and health care

How does liver cirrhosis break, bleed dangerously to predict _'s prevention and health care
The liver cirrhosis esophagus is variceal to break, bleed dangerous prediction
Liver cirrhosis patient have, 5% take place after the l annual variceal esophagus having 10%-20% while as a child variceal to develop into the loud one to be variceal nearly every year, the danger bleeding in 2 years is 20%- 30%, the first bleeding l case fatality rate in week is 25%- 50%. So, prevent from bleeding accurately and choose operation way to prevent and cure and bleed rationally, improve curative effect and judge the prognosis is extremely important. It is sensitive, peculiar not to but does not have yet at present, also there are not the prediction means of wound, agony. Assign to and state commonly used prediction method and pros and cons as follows now.
1,The mirror checks an intravenous nodular expansion of oesophageal song under gastroscope in the upper digestive tract, red earthworm soliciting and bright cherry-red kind of intensity changed while soliciting, predict the important index bleeding.
2,Intravenous pressure gradient (HVPG) of liver Door pulse and high pressure are variceal foundation that is formed of the esophagus, HVPGlt; 1.5kPa(12mmHg) Not bleeding dangerously hour, gt; 2.0Kpa (15mmHg) Can cause the esophagus to be variceal hour. gt; 3.IkPa(23.25mmHg) Have danger of esophaguses happen variceally and breaking to bleed promptly hour. But HVPG determines that has wound nature, fails to be regarded as routine inspection clinically; And even some patients make a definite diagnosis of door pulse and high pressure, it is variceal that there might not be esophagus either.
3,Spider's pile spider has positive at age lt pile; In 60 years old and liver function better patient, to indicating the value bleeding is relatively big. Spider's pile counts lt; The bleeding chance of 20 person is 50%, the bleeding chance of the person who has multiple atypical spider's pile is 63%, there are large piles (diameter gt; 15mm) Bleeding probability 80%. Do not have statistics report to its specificity and sensitiveness yet.
4,Check the B -type supersound and measure the internal diameter of portal vein and is no more than 1.5cm, spleen intravenous internal diameter and greater than equalling 1.0cm in supersound, short intravenous internal diameter of the stomach is greater than 10mm, can be regarded as the reference index of predicting variceal bleeding of esophagus.
5,The blood vessel of optical fundus can also reflect to detect the change of blood vessel of optical fundus liver cirrhosis whole body blood vessel and blood flow are unusual in dynamics in early days, shown as the optical fundus vein is expanded, the artery is attenuated, even the vein is highly crooked, ooze out things on a small quantity on the retina. Change, aggravate with the blood vessel of optical fundus, the door, spleen vein are increased widely, eating the camp variceally breaks the bleeding rate to obviously increase, it is the positive correlation. Jointly detect value with the B -type supersound relatively tallly.
6,Check lt of blood platelet in the laboratory; 100*109 L, thrombinogen activity degree lt; 70%, the diameter gt of portal vein at the same time; 13mm, the esophagus that 56% of the patients exist is variceal, 16% among them are a vein of thick song, can be regarded as and predicted the index. But its specificity or sensitiveness has not been up to 75%.
|