Study On Risk Factors Of Hepatic Encephalopathy After TIPS For Liver Cirrhosis

Objective To understand the circumstances of symptom relief and appearing complications in patients with cirrhosis and portal hypertension after transjugular intrahepatic portosystemic shunt,analyze their clinical characteristics,explore the risk factors of hepatic encephalopathy after TIPS,and provide reference for clinical prevention.Methods The clinical data of patients who were treated with TIPS in the General Hospital of Ningxia Medical University from May 2019 to December 2020 due to cirrhosis and portal hypertension were retrospectively collected.105 patients who met the study design were included in the study,and the occurrence of complications after TIPS was statistically analyzed.According to the occurrence of hepatic encephalopathy within 1 year after TIPS,the subjects were divided into case group and control group,and analyzed with statistical software.First of all,the factors with P<0.2 were screened by single factor analysis and included in the logistic regression model to explore the risk factors related to the occurrence of hepatic encephalopathy within 1 year after the initial TIPS treatment.Then,the patients in the group with hepatic encephalopathy after TIPS were divided into two groups according to whether the number of hospitalizations for hepatic encephalopathy was less than 3,and the risk factors affecting the recurrence of hepatic encephalopathy after TIPS were discussed.Results Within one year after TIPS,8.6%(9/105)of patients were hospitalized for upper gastrointestinal bleeding,4.8%(5/105)of patients were hospitalized for ascites,and 32.4%(34/105)of the patients suffered from hepatic encephalopathy,of which about 20.6%(7/34)of patients were hospitalized for hepatic encephalopathy more than or equal to 3 times.In the analysis of the risk factors affecting the occurrence of hepatic encephalopathy after TIPS treatment,it was found that there was a statistically significant difference between the two groups when spontaneous portosystemic shunt was found during TIPS operation but the shunt vessel was not embolized(OR=7.1,95%CI 1.7-30.4,P=0.008),and there was a statistically significant difference between the two groups in irregular oral administration of blood ammonia lowering drugs and restriction of high-protein diet after operation(OR=14.4,95%CI 1.2-171.8,P=0.035);When analyzing the risk factors that affect the recurrence of hepatic encephalopathy after TIPS,the results of univariate analysis showed that there was a statistical difference in the distribution of preoperative hemoglobin count between the two groups(z=-3.0,P=0.002),the average number of preoperative fibrinogen quantification between the two groups was statistically different(t=-2.5,P=0.017),and the distribution of the international standard ratio of prothrombin between the two groups was statistically different(z=-2.0,P=0.039).Conclusion1.The absence of spontaneous portal vein shunt embolization during TIPS surgery is a risk factor for the occurrence of hepatic encephalopathy after TIPS surgery.2.Regularly taking blood ammonia lowering drugs and limiting a high protein diet can reduce the incidence of hepatic encephalopathy after TIPS surgery.