Effect Of Hemoglobin Level On The Therapeutic Effect Of Esophageal Variceal Ligation

Objective:To investigate the effects of preoperative hemoglobin(Hb)levels on the ligation time and efficacy of patients with esophageal variceal bleeding(EVB)undergoing esophageal variceal ligation(EVL).Methods:393 patients with cirrhotic esophageal varices were collected(including 229 patients with EVL in the bleeding group,116 patients without EVL in the bleeding group,and 48 patients in the EVL group without bleeding).The collected indicators included general data,blood routine,blood biochemistry,ascites degree,Child.Pugh grade of liver function,portal vein diameter,portal vein thrombosis,admission to EVL time,blood transfusion,early rebleeding rate,total hospitalization costs,mortality,and other biochemical and clinical indicators.By t test,chi-square test,one-way ANOVA,nonparametric test,binary logistic regression to analysis the effect of different preoperative Hb level with EVL on ligation time and early rebleeding.Results:There was no significant difference in early rebleeding rate andmortality between the patients in different hemoglobin groups with EVB(50g/L≤Hb≤60g/L,60g/L<Hb≤70g/L,Hb>70g/L)and the group without bleeding(χ~2=2.173,P=0.567;χ~2=3.404,P=0.296),there were significant differences in preoperative blood transfusion,postoperative blood transfusion and total transfusion between the four groups(χ~2=39.009,P=0.000;χ~2=25.478,P=0.000;χ~2=77.055,P=0.000),the difference in total hospitalization costs was statistically significant(χ~2=38.487,P=0.000).There was no significant difference in early rebleeding rate and mortality between different Hb groups(P>0.05).Compared with EVL group without bleeding,there were significant differences in preoperative,postoperative,total blood transfusion volume and total hospitalization costs between patients in different Hb groups(P<0.05),the blood transfusion volume and total hospitalization costs in EVL group without bleeding were less.There was no significant difference in the time from admission to EVL in different Hb groups(P>0.05),but the lower the Hb group,the lower the ligation time.There were statistically significant differences in the rate of early rebleeding and mortality between the patients with EVL in the bleeding group(ligation time≤1d,>1d)and those patients without EVL in the bleeding group(χ~2=19.621,P=0.000;χ~2=17.339,P=0.001),there was a statistically significant difference in the total amount of blood transfusion and total hospitalization costs between the three groups(χ~2=11.887,P=0.003;χ~2=53.246,P=0.000).Compared with the latter group,there were significant differences in early rebleeding rate,mortality rate and blood transfusion volume between the former two groups(P<0.05).Early rebleeding rate,mortality rate and blood transfusion volume in the latter group were significantly reduced.There was no significant difference between patients in different Hb groups and different groups of ligation time(χ~2=0.603,P=0.759).Binary logistic regression analysis was performed in patients with cirrhosis,EVL(OR=0.281,P=0.004),portal vein diamete(OR=5.266,P=0.046),Hb after treat(OR=0.964,P=0.004),platelet after treatment(OR=1.004,P=0.021)and white blood cell after treatment(OR=1.170,P=0.003)were risk factors for early rebleeding in 393 patients with esophageal varices.And platelet after treatment(OR=1.007,P=0.034),preoperative blood transfusion(OR=1.001,P=0.007)were risk factors for early rebleeding in229patients with EVB undergoing EVL.Conclusion:Patients with EVB due to cirrhosis,the preoperative Hb in different groups had no significant effect on the efficacy of EVL in different time groups.The lower the Hb group,the lower the ligation time,so the cirrhosis patients with EVB when Hb≥50g/L,EVL can be considered actively to avoid the loss of rescue time due to the inability to timely transfusion;cirrhosis patients with EVB undergoing EVL compared with patients without EVL,early rebleeding rate,mortality is significantly reduced;the use of EVL in the prevention and treatment of esophageal varices in patients with liver cirrhosis can further reduce the amount of blood transfusion,save hospitalization costs and reduce the burden of patients.