臺灣博碩士論文加值系統

本研究旨在探討食道靜脈瘤出血病患照護成效之影響因素，作為照護計畫之參考。採回溯性描述性研究，2008年1月至2012年12月於南部某醫學中心，肝硬化或肝癌合併食道靜脈瘤出血，接受標準作業流程治療的病患為對象。其中接受食道球及食道靜脈瘤結紮者僅有41人，另採分層取樣每年隨機抽取37-38位食道靜脈瘤結紮者186人，兩者總計227人，以SPSS 18.0版統計軟體進行T檢定（Independent t test）、卡方檢定（Chi-Square test）、單因子變異數分析（One way ANOVA）、單變項相關分析(Correlation)、邏輯斯迴歸(Logistic regression)及複迴歸分析(Multiple Liner Regression Analysis)。

結果顯示住院天數預測因子是肝性腦病變、感染、治療方法，總體解釋力26.9 ％。食道球不良反應主因是食道球壓力(t=-2.23，p =.033，β= -0.040）及食道球深度(t=2.091，p =.45，β=0.034），總體解釋力22.1％。3天止血率預測因子是肝性腦病變及靜脈瘤嚴重度，總體解釋力為14.4％。5天死亡率預測因子為凝血酶原時間、INR比值、肌酸酐、肝性腦病變、靜脈瘤嚴重度及顏色RWM，總體解釋力26.3％。42天死亡率預測因子包括感染、總膽紅素、重度肝硬化、治療方法及靜脈瘤顏色CRS+++，總體解釋力34.6％。42天再出血率預測因子感染、治療方法及預防性藥物，總體解釋力21.8％。

影響食道靜脈瘤出血照護成效最重要的因素是肝臟功能障礙，指標包括肌酸酐、肝性腦病變、凝血酶原時間、INR比值等，因此，減緩肝臟疾病進展是很重要的議題，宜宣導肝病防治方法及肝炎者定期追蹤的重要性。

This study aimed to investigate the factors affecting the effectiveness of care for patients presenting with esophageal variceal bleeding by using retrospective descriptive method. Between January 2008 and December 2012, patients with cirrhosis or hepatocellular carcinoma (HCC) presenting with esophageal variceal bleeding who received standard operating procedures at a medical center in southern Taiwan were evaluated. Forty-one patients were treated by both Sengstaken–Blakemore (SB) tube and esophagus variceal banding ligation (EVL). In addition, 37-38 patients per year x 5 years treated by EVL alone were collected for comparison (186 people). Therefore, a total of 227 people were enrolled. By using SPSS 18.0 statistical software version, data were analysed by Independent t test, chi-square test, single-factor analysis of variance (One way ANOVA), univariate correlation analysis (Correlation), logistic regression and multiple liner regression test.

The results showed that the number of hospital days were predictable by hepatic encephalopathy, infection, treatment methods, with an overall power of 26.9%. SB tube pressure (t = -2.23, p = .033, β = -0.040) and depth of insertion of SB tube (t = 2.091, p = .45, β = 0.034) were the main causes of adverse events, with an overall power of 22.1%. Hemostasis within the first three days was predictable by hepatic encephalopathy and severity of varices, with an overall power of 14.4%. Mortality within 5 days was predictable by prothrombin time, INR ratio, creatinine, hepatic encephalopathy, severity of color (RWM) of varices, with an overall power of 26.3%. In addition, 42-days mortality was predictable by infection, total bilirubin level, severe cirrhosis, and methods of treatment and variceal color (CRS+++), with an overall power of 34.6%. 42-days rebleeding rate was predictable by infection, methods of treatment and preventive medicine, with an overall power of 21.8%.

The significant factors affecting the effectiveness of care for patients presenting with esophageal variceal bleeding are the liver function indexes eg. creatinine, hepatic encephalopathy, prothrombin time, INR ratio etc. Thus, to advocate the liver disease prevention and monitor closely are important strategies to postpone the liver disease progression.

目 錄
中文摘要 …………………………………………………………………………… i
英文摘要 ………………………………………………………………… ii
誌謝 ……………………………………………………………………… iii
目錄 …………………………………………………………………………… iv-v
表目錄 ………………………………………………………………vi-vii
圖目錄 ……………………………………………………………………… viii
第一章 緒論--------------------------------------- 1-4
第一節 研究背景、重要性及動機-------------------- 1-3
第二節 研究目的-------------------------------- 4
第二章 文獻查證----------------------------------- 5-25
第一節 食道靜脈瘤的定義、診斷及分期----------------- 5-7
第二節 食道靜脈瘤的治療---------------------------- 8-15
第三節 食道球壓迫止血法-------------------------16-18
第四節 食道靜脈瘤出血之實証研究------------------19-25
第三章 研究方法--------------------------------26-43
第一節 研究設計----------------------------------------26
第二節 研究架構---------------------------------------- 27
三節 研究假設---------------------------------------- 28
第四節 研究對象與資料來源------------------------------29-31
第五節 研究工具與效度測量-------------------------------32-35
第六節 名詞解釋、研究變項名稱及操作型定義-----------------36-39
第七節 資料蒐集過程------------------------------------40-42
第八節 資料整理與分析----------------------------------- 43
第四章 研究結果--------------------------------------44-86
第一節 基本屬性、疾病特性、醫療處置及照護成效之分布-------44-48
第二節 病患基本屬性對照護成效的影響----------------------49-54
第三節 疾病特性對照護成效的影響-------------------------55-67
第四節 醫療處置對照護成效的影響--------------------------68-72
第五節 基本屬性、疾病特性、醫療處置與照護成效之影響因素----73-86
第五章 討論-------------------------------------------87-95
第一節 基本屬性、疾病特性、醫療處置及照護成效分布之探討----87-88
第二節 病患特性、醫療處置與住院(加護)天數之探討-----------88-89
第三節 食道球與不良反應之探討---------------------------89-90
第四節 研究樣本與照護成效之相關性探討--------------------90-95
第六章 結論與建議-------------------------------------96-98
第一節 研究結論及建議----------------------------------96-97
第二節 研究結果之應用----------------------------------97-98
第三節 研究限制------------------------------------------98
參考文獻 99-106
中文部份 -------------------------------------99-100
英文部份 ------------------------------------100-106
附件一、病歷審查紀錄表------------------------------------107
附件二、人體試驗計畫同意函---------------------------------108

表目錄
表1、靜脈瘤出血相關治療成效之文獻整理----------------------23-25
表2、病歷審查記錄表之專家內容效度相關性(CVI)結果------------- 33
表3、病歷審查記錄表之專家內容效度邏輯性(CVI)結果------------- 34
表4、病歷審查記錄表之專家內容效度適當性(CVI)結果------------- 35
表5、Child-Pugh Classification-------------------------- 36
表6、研究變項及操作型定義-------------------------------38-39
表7、資料統計分析--------------------------------- 43
表8.1、研究樣本屬性、疾病特性、醫療處置及照護成效之描述性統計-- 46
表8.2、研究樣本屬性、疾病特性、醫療處置及照護成效之描述性統計-- 47
表8.3、食道球不良反應之分布情形------------------------------48
表8.4、食道球不良反應項目之分布---------------------------- 48
表9、研究樣本基本屬性與照護成效之關係，按類別變項------------ 50
表10、研究樣本基本屬性與照護成效之卡方檢定-------------------54
表11.1、研究樣本疾病特性與照護成效之獨立T檢定--------------- 57
表11.2、研究樣本疾病特性與照護成效之單因子變異數分析--------- 58
表11.3、研究樣本疾病特性與照護成效之之Pearson’s相關分析----- 59
表11.4、研究樣本屬性及疾病特性與住院天數之複迴歸分析------- 60
表11.5、研究樣本屬性及疾病特性與住加護病房天數之複迴歸分析-- 60
表12.1、研究樣本疾病特性與照護成效之卡方檢定分析-------- 66
表12.2、研究樣本疾病特性與照護成效之卡方檢定分析-------- 67
表13、研究樣本醫療處置與照護成效之獨立T檢定------------ 68
表14、研究樣本醫療處置與照護成效之Pearson’s相關分析------ 69
表15、研究樣本疾病特性與照護成效之卡方檢定分析-------- 72
表15.1、研究樣本與3天止血率之邏輯斯迴歸分析------------- 77
表15.2、研究樣本與3天止血率之複迴歸分析-------------- 77
表16.1、研究樣本與5天再出率之邏輯斯迴歸分析----------- 78
表16.2、研究樣本與5天再出血率之複迴歸分析------------ 78
表17.1、研究樣本與5天死亡率之邏輯斯迴歸分析------------ 79
表17.2、研究樣本與5天死亡率之複迴歸分析---------------- 79
表18.1、研究樣本與42天再出血之邏輯斯迴歸分析------- 80
表18.2、研究樣本與42天再出血之複迴歸分析--------------- 81
表19.1、研究樣本與42天死亡率之邏輯斯迴歸分析----------- 82
表19.2、研究樣本與42天死亡率之複迴歸分析------------- 83
表20.1、研究樣本與42天再入院之邏輯斯迴歸分析----------- 84
表20.2、研究樣本與42天再入院之複迴歸分析------------ 84
表21.1、研究樣本與食道球不良反應之邏輯斯迴歸分析------- 85
表21.2、研究樣本與食道球不良反應之複迴歸分析----------- 85
圖1、食道球-------------------------------------------- 16
圖2、研究架構------------------------------------- 27
圖3、食道靜脈瘤出血處理流程------------------------ 30
圖4、收案流程------------------------------------- 31
圖5、研究步驟流程圖-------------------------------- 41
圖6、資料收集流程--------------------------------- 42

中文部分
行政院衛生署(民100)。100年死因統計結果分析。http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspxnow_fod_list_no=12336&;class_no=440&;level_no=4
〔Executive Yuan, Taiwan, ROC,Department of Health. (2011). 100 year cause of death statistics. Retrieved from http://www.doh.gov.tw/CHT2006/D M/DM2_2.aspx?now_fod_list_no=12336&;class_no=440&;level_no=4〕

石崇良(民97）。醫療團隊合作與病人安全。澄清醫護管理雜誌，4(1)，4-9。
〔Shih, C. L. (2008). Medical teamwork and patient safety. Cheng Ching Medical Journal, 4(1), 4-9.〕
林志陵、高嘉宏（民98）。肝癌危險因子和流行病學之變遷。當代醫學，423，25-32。〔Lin, C. L., &; Kao, J. H. (2008). Epidemiology of Hepatocellular Carcinoma. J.Chinese Oncol. Soc, 24(5), 277-281.〕
洪欣妏、蕭宇伶、楊玫蓉、劉中賢、陳誠仁、嚴元鴻(民100)。導入醫療團隊資源管理（TRM）對提升醫療品質效應初探-以某區域醫院住院病人滿意度為例。醫療品質雜誌，5(3)，48-56。
〔Hong, X.W., Xaio, Y. L., Young, M, R., Liu, C. X., Chen, C. R., &; Yan, Y. h. (2011). Import medical team resource management (TRM) to enhance the effect of the quality of medical care to a regional hospital in-patients satisfaction, for example. Journal of Healthcare Quality,5(3), 48-56.〕
劉育穎(民96)。食道靜脈瘤出血預後及其影響因子探討。取自臺灣博碩士論文系統。(系統識別號U0007-2407200722283400)
〔Liu, Y. Y. (2007). A study on prognostic factors of esophageal vericeal bleeding. Retrieved from http://ndltd.ncl.edu. tw/cgi-bin/gs32 /gsweb.cgi/ccd=.Id0kU/record?r1=1&;h1=0〕
劉越萍(2008)。利用醫療團隊訓練以促進病人安全。醫療品質雜誌，3(1)，68-72。
〔Liu, Y. P. (2009). The use of medical team training to improve patient safety. Journal of Healthcare Quality,3(1), 68-72.〕
賴輝雄、溫燕霞、張其純、黃純貞、吳信昇(民98)。血管收縮作用劑在肝硬化引起食道靜脈瘤出血患者的使用評估。臺灣臨床藥學雜誌，3，65-79。〔Lai, H. H., Wen, Y. H., Chang, C. C., Huang, C. C., &; Wu, S. S. (2009).Retrospective evaluation of vasoactive agents in esophageal variceal bleeding induced by liver cirrhosis. Formos a Journal of Clinical Pharmacy, 7(3),65-79.〕
醫院評鑑暨醫療品質促進會（民100）。台灣臨床成效指標。取自http://www
.tzuchi.com.tw/a_f/f_hl/download/
〔Taiwan Join Commission on Hospital Accreditation.(2011).Taiwan clinical performan
-ce indicator. Retrieved from http://www.tzuchi. Com.tw
/a_f/f_hl/download/ files/file-01-01-01.pdf〕
英文部分
Agarwal, R., Aggarwal, A. N., &; Guptaupta, D.(2008). Endo
-bronchial malposition of Sengstaken-Blakemore tube. The Journal of Emergency Medicine, 34(1), 93–94.
Abid, S., Jafri, W., Hamid, S., Salih, M., Azam, Z., Mumtaz K., …Abas, Z. (2009). Terlipressin vs. octreotide in bleeding esophageal varices as an adjuvant therapy with endoscopic band ligation: a randomized double-blind placebocontrolled trial. American Journal of Gastroent-
erology, 104, 617-623. doi: 10.1038/ajg.2008.147
Abraldes, J. G., Villanueva, C., Banares, R., Aracil, C., Catalina, M. V., Garcia-Pagan, J. C.,&; Bosch, J. (2008). Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic therapy. Journal of Hepatology,48(2),229-236.
Augustin, S., Altamirano, J., González, A., Dot, J., Abu-Suboh, M., Armengol JR, …Genescà, J. (2011). Effectiveness of combined pharmacologic and ligation therapy in high-risk patients with acute esophageal variceal bleeding. Am J Gastroenterol, 106(10),1787-1795. doi: 10.1038/ajg.2011.173
Bambha, K., Kim W. R., Pedersen, R. A., Bida, J. P., Kremers
, W. K., &; Kamath, P. S. (2008). Predictors of Early rebleed
-ing and mortality after acute variceal hemorrhage in patients with cirrhosis. Gut. 2008; 57:814-820
Bruha, R., Marecek, Z., Prochazka, V., Lata, J., Spicak, J., Ehrmann, J., …Vrzalova, D.(2009). Double-blind randomized multicenter study comparing the efficacy and safety of 10-day to 5-day terlipressin treatment of bleeding esophageal varices. HepatoGastrEnterology,56,390-394.
Bendtsen, F., Krag, A., &; Møller S. (2008). Treatment of acute variceal bleeding. Digestive and Liver Disease, 40, 328-336. doi:10.1016/j.dld.2007.12.005
Beppu, K., Inokuchi, K.,Koyanagi, N.,Nakayama, S.,Sakata, H., Kitano, S.,&; Kobayashi,M. (1981). Prediction of variceal hemorrhage by esophageal endoscopy.Gastrointest-
inal Endoscopy, 27(4), 213-218.
Bosch, J., Berzigotti, A., Garcia-Pagan, J. C., &; Abraldes, J. G. (2008). The management of portal hypertension: Rational basis,available treatments and future options. Journal of Hepatology, 48, 68-92. doi:10.1016/j.jhep.2008
.01.021
Berzigotti, A., &; Garcia-Pagan, J.C. (2008). Prevention of recurrent variceal bleeding.Digestive and Liver Disease, 40, 337-342. doi:10.1016/j.dld.2007.12.003
Cheung, J., Soo, I., Bastiampillai, R., Zhu, Q., &; Ma, M. (2009). Urgent vs. non-urgent endoscopy in stable acute variceal bleeding. American Journal of Gastroenterology,
104(5), 1125–1129. doi:10.1038/ajg.2009.78
Cheung, J., Zeman, M., Zanten, S. V. V., &; Tandon, P. (2009). Systematic review: secondary prevention with band ligation, pharmacotherapy or combination therapy after bleeding from oesophageal varices. Alimentary Pharmacology &; Therapeutics, 30. 577-588.
Cordon, J. P., Torres, C. F., García, A. B., Rodriguez, F. G., &; Suárez de Parga, J. M. (2012). Endoscopic management of esophageal varices. World Journal Gastrointestinal Endo-
scopy, 4(7), 312-322. doi: 10.4253/wjge.v4.i7.312
Correia, J. P., Alves, M. M., Alexandrino, P., &; Silveira, J. (1984).Controlled Trial of Vasopressin and Balloon Tamponade in Bleeding Esophageal arices. Hepatology, 4(5), 885-888. doi:10.1111/j.1365-2036.2009.04075.x
Collyer, T. C., Dawson, S. E. T., &; Earl, D. (2008).Acute upper airway obstruction due to displacement of a Sengstaken-Blakemore tube. European Journal of
Anaesthesiology, 25(4), 341-342.doi:10.1017/S026502150700285
Dawson, B., &; Trapp, R.G. (1990) .Statistical Methods For Multiple Variable. Basic and Clinical Biostatistics(pp.125). London: Prentice Hall.
Escorsell, A., &; Bosch, J. (2011). Review Article Self-ExpandableMetal Stents in the Treatment of Acute Esophageal Variceal Bleeding. Gastroenterology Research and Practice, 9, 1-6. doi:10.1155/2011/910986
Fabrizi, F., Dixit, V., Messa, P., &; Martin, P. (2009). Terlipressin for hepatorenal syndrome: A meta-analysis of randomized trials. Int J Artif Organ., 32(3), 133-40.
Garcia-Tsao, G., &; Bosch J. (2010). Management of varices and variceal Hemorrhage in cirrhosis. New England journal of medicine,362(9),823–832.
Garcia-Tsao, G., Bosch, J.,&; Groszmann, R. J. (2008). Portal Hypertension and Variceal Bleeding—Unresolved Issues. Summary of an American Association for the Study of Liver Diseases and European Association for the Study of the Liver Single-Topic Conference. Hepatology, 47(5), 1764-1772. DOI 10.1002/hep.22273
García-Pagán, J. C., Caca, K., Bureau, C., Laleman, W., Appenrodt, B., Luca, A., …Bosch, J. (2010). Early Use of TIPS in Patients with Cirrhosis and Variceal Bleeding. New england journal of medicine, 362, 2370-2379. doi: 0.1056/
NEJMoa0910102
Garcia-Pagan, J. C., Gottardi, D. A., &; Bosch, J. (2008). Review article: the modern management of portal hypertension
-primary and secondary prophylaxis of variceal bleeding in cirrhotic patients. Aliment Pharmacol Ther, 28(2), 178–186. doi: 10.1111/j.1365-2036. 2008.03729.x
Gulzar, G. M., Zargar S. A., Jalal S., Alai M. S., Javid G., Suri P. K., ... Dar, G. A. (2009). Correlation of hepatic venous pressure gradient with variceal bleeding, size of esophageal varices, etiology, ascites and degree of liver dysfunction in cirrhosis of liver. Indian Journal of Gastroenterology, 28(2), 59-61.
Jairath, V., Kahan, B. C., Logan, R. F. A., Hearnshaw, S. A., Travis, S. P. L., Murphy M. F., &; Palmer, K. R. (2011). Mortality From Acute Upper Gastrointestinal Bleeding in the United Kingdom: Does It Display a “Weekend Effect”?. American Journal of Gastroenterology, 106, 1621-1628. doi:10.1038/ajg.2011.172
Khaliq, A., Dutta, U., Kochhar, R., &; Singh, K. (2011). Pressure necrosis of alanasi by Sengstaken-Blackemore tube. Indian J Gastroenterol, 30(1), 51. doi: 10.1007/ s12664- 011-0091-y
Krige, J. E. J., Kotze, U. K., Distiller, G., Shaw J. M., &; Bornman, P. C. (2009). Early rebleeding and death at 6 weeks in alcoholic cirrhotic patients with acute variceal bleeding treated with emergency endoscopic injection sclerotherapy. South African journal Surgery, 47(3), 72-79.
Kumar, A., Sharma, P., &; Sarin, S. K. (2008). Review-Hepatic venous pressure gradient measurement:Time to learn. Indian Society of Gastroenterology, 27(2), 74-80.
Lo, G. H. (2010). Management of acute esophageal variceal hemorrhage. Kaohsiung Journal of Medical Sciences, 26(2), 55–67.
Lo, G. H., Chen, W. C., Chan, H. H., Tsai, W. L., Hsu, P. I., Lin, C. K., …Lai, K. H. (2009). A randomized, controlled trial of banding ligation plus drug therapy versus drug therapy alone in the prevention of esophageal variceal rebleeding. Journal of Gastroenterology and Hepatology, 24,982-987. doi:10.1111/j.1440-1746.2009.05792.x
Lo, G. H., Chen, W. C., Lin, C. K., Tsai, W. L., Chan, H. H., Chen, T. A., …Lai, K H. (2008). Improved survival in patients receiving medical therapy as compared with banding ligation for the prevention of esophageal variceal rebleeding. Hepatology, 48(2), 580–587. doi:10.1002
/hep.22358
Lo, G. H., Chen, W. C., Wang, H. M., Lin, C. K., Chan, H. H., Tsai, W. L., …Tsay, F. W. (2009). Low-dose terlipressin plus banding ligation versus low-dose terlipressin alone in the prevention of very early rebleeding of oesophageal varices, Hepatology, 58(9), 1275-1280. doi:10.1136/gut.2008.165910
Lo, G. H., Chen, W. C., Wang, H. M., &; Yu, H. C. (2012). Randomized controlled trial of carvedilol versus nadolol plus isosorbide mononitrate for the prevention of variceal rebleeding. Journal of Gastroenterology and Hepatology, 27(11), 1681-1687. doi: 10.1111/j.1440-1746.2012.07244.x
Li, L., Yu, C., &; Li, Y. (2011). Endoscopic band ligation versus pharmacological therapy for variceal bleeding in cirrhosis: a meta-analysis. Canadian Journal Gastroente-
rology, 25(3), 147–155
Liu, J. S., &; Liu, J. (2009). Comparison of emergency endoscopic variceal ligation plus octride or octride alone for acute esophageal variceal bleeding. Chinese Medical Journal, 122(24), 3003-3006. doi: 10.3760/cma.j.issn.0366-6999.2009.24.017
Lin, C. T., Huang, T. W., Lee, S. C., Kuo, S. M., Hsu, K. F., Hsu, P. S., …Chang, H.(2010). Sengstaken-Blakemore tube related esophageal rupture. Rev Esp Enferm, 120(6), 395
-396. doi: 10.4321/S1130-01082010000600014
Luz, G. O., Maluf-Filho, F., Matuguma, S. E., Hondo, F. Y., Ide, E., Martins, J. M., …Sakai, P. (2011). Comparison between endoscopic sclerotherapy and band ligation for hemostasis of acute variceal bleeding. World Journal of Gastrointestinal Endoscopy, 3(5), 95–100. doi:10.4253
/wjge.v3.i5.95
Martinez, A. A. (2009). Survival of patients with cirrhosis after acute variceal bleeding.Revista Espanola Denfermedes Digestivas, 101 (4), 231-235.
Miñano, C., &; Garcia-Tsao, G. (2010). Portal Hypertension. Gastroenterol Clin North Am, 39(3), 681–695. doi:10.1016/
j.gtc.2010.08.015
Matull, W. R., Cross, T. J. S., Yu, D., Winslet, M. C., &; O'Beirne, J.(2008). A removable covered self-expanding metal stent Gastroenterology Research and Practice for the management of Sengstaken-Blakemore tube-induced esophageal tear and variceal hemorrhage. Gastrointestinal Endoscopy, 68(4), 767-768
Moodley, J., Lopez, R., &; Carey, W. (2010). Compliance With Practice Guidelines and Risk of a First Esophageal Variceal Hemorrhage in Patients With Cirrhosis. Clinical Gastro-
enterolgy and Hepatolgy, 8(8), 703–708. doi:10.1016 /j.cgh.2010.02.022
Nielsen, T. S., &; Charles, A. V. (2012). Lethal esophageal rupture following treatment with Sengstaken–Blakemore Tube in management of variceal bleeding: A 10-year autopsy study. Forensic Science International, 222(1), 19-22. doi: org/10.1016/j.forsciint.2012.05.024
Nezam, H., Afdhal, &; Curry, M. P. (2010).Early TIPS to Improve Survival in Acute Variceal Bleeding. New england journal of medicine, 24, 2421-2422.
Orloff, M. J., Isenberg, J. I., Wheeler, H. O., Haynes, K. S., Jinich-Brook, H., Rapier, R.,… Hye, R. J. (2011). Direct Costs of Care in a Randomized Controlled Trial of Endoscopic Sclerotherapy versus Emergency Portacaval Shunt for Bleeding Esophageal Varices in Cirrhosis—Part 4. Journal of Gastrointestinal Surgery, 15(1), 38-47. Doi: 10.1007/s11605-010-1332-6
Petraschm, F., Grothaus, J., Mössner, J., Schiefke, I., &; Hoffmeister, A. (2010). Differences in bleeding behavior after endoscopic band ligation: a retrospective analysis. BMC Gastro- enterology, 10(5), 5-10. doi:10.1186/1471-230X-10-5
Pugh, R. N. H., Murray-Lyon, I. M., Dawson, J. L.,Pietroni, M. C., &; Wil- liams, R. (1973). Transection of the
oesophagus for the bleeding varices. British Journal of Surgery , 60(3), 646–649.
Pinto-Marques, P., Romaozinho, J. M., Ferreira ,M., Amaro, P.,&; Freitas, D. (2006). Esophageal perforation – associated risk with balloon tamponade after endoscopic therapy. Myth or reality?. Hepatogastroenterology, 53(70), 536-539.
Ravipati, M., Katragadda, S., Swaminathan, P. D., Molnar, J., &; Zarling, E. (2009).Pharmacotherapy plus endoscopic intervention is more effective than pharmacotherapy or endoscopy alone in the secondary prevention of esophageal variceal bleeding: a meta-analysis of randomized,controlled trials. Gastrointestinal Endoscopy, 70(4), 658–664. doi:10.
1016/j.gie.2009.02.029
Reverter, E., &; García-Pagán, J. C.(2012). Review Management of an acute variceal bleeding episode. Clinical Liver Disease, 1(5), 151-154. doi: 10.1002/cld.82
Santos, M. M. M., Tolentino, L. H. L., Rodrigues, R. A., Nakao, F. S., Rohr, M. R. S., Paulo, D., … Libera, E. D. (2011). Endoscopic treatment of esophageal varices in advanced liver disease patients: band ligation versus cyanoacrylate injection. Eur J Gastroenterol Hepatol, 23(1), 60-65. doi: 10.1097/MEG.0b013e3283415986
Seet, E., Beevee, S., Cheng, A., &; Lim, E. (2008). The Sengstaken-Blakemore tube:uses and abuses. Singapore Med J, 49(8), 195-197.
Singla, A., Hart, J. L., Li, Y. F., Tseng, J. F., &; Shah, S. A. (2011).Hospitalization for Complications of Cirrhosis
: Does Volume Matter? J Gastrointest Surg,15, 330–335. Doi: 10.1007/s11605-010-1398-1
Sempere, L., Palazon, J. M., nchez-Paya, S. J., Pascual, S., Madaria, E., Poveda, M., J., …Perez-Mateo, M. (2009). Assessing the short- and long-term prognosis of patients with cirrhosis and acute variceal bleeding. Rev Esp Enferm Dig (Madrid), 101(4),236-248.
Triantos, C. K., &;. Burroughs, A. K. (2008). Treatment of acute variceal bleeding. Annals of Gastroenterolody, 21(3), 157-163.
Thomson, A. (2009). Safe and efficacious placement of Sengstaken- Blakemore tubes.Gastrointestinal Endoscopy, 70(2), 401.
Toubia, N., &; Sanyal, A. J.(2008). Portal Hypertension and Variceal Hemorrhage. Medical Clinics of North America,92, 551-574. doi:10.1016/j.mcna.2007.12.003
Tripathi, D., Ferguson, J. W., Kochar, N., Leithead, J. A., Therapondos, G., Mcavoy, N. C., ... Haye, P. C. (2009). Randomized controlled trial of carvedilol versus variceal band ligation for the prevention of the first variceal bleed. Hepatology, 50(3), 825-833. doi: 10.1002/hep.23045
Vlavianos, P., Gimson, A. E., Westaby, D., &; Williams, R. (1989). Balloon tamponade in variceal bleeding: use and misuse. BMJ, 298, 1158-1159.
Villanueva, C., Aracil, C., Colama, A., Hernandez-Gea, V., Lopez-Balaguer, J. M., Alvarez-Urturi, C., …Guarner, C.(2009). Acute hemodynamic response to beta-blockers and prediction of long-term outcome in primary prophylaxis of variceal bleeding. Gastroenterology, 137, 119-128. doi:10.
1053/j.gastro.2009.03.048
Villanueva, C., &; Balanzó, J. (2008). Variceal bleeding pharmacological treatment and prophylactic strategies. Drugs, 68(16), 2303-2324. doi: 10.2165/0003495-200868
160-00004.
Vlachogiannakos, J., Kougioumtzan, A., Triantos, C., Viazis, N., Sgouros, S., Manolako-poulos, S., … Karamanolis, D. G. (2007). Clinical trial: the effect of somatostatin vs. octreotide in preventing post-endoscopic increase in hepatic venous pressure gradient in cirrhotics with bleeding varices. Alimentary Pharmacology&; Therapeutics
, 26, 1479-1487. doi:10.1111/j.1365-2036.2007.03539.x
Wells, M., Chande, N., Adams, P., Beaton, M., Levstik, M., Boyce, E., Mrkobrada, M.(2012). Meta-analysis: vasoactive medications for the management of acute variceal bleeds. Alimentary Pharmacology &; Therapeutics, 35(11), 1267-1278. doi: 10.1111/j.1365-2036.2012.05088.x
Wundke, R., Altus, R., Sandford, J., &; Wigg, A. (2010). Improving management of oesophageal varices in patients with cirrhosis. Qual Saf Health Care, 19,536-541. doi:10.
1136/qshc.2009.036525
Wee, E., &; Cheng, L. H. (2012). Inserting the Sengstaken-Blakemore tube successfully in a difficult case of uncontrollable esophageal variceal bleeding, using sutures and an endoscope. Trop Gastroenterol, 33(1),65-67.
Wang, M. H., Lin, M. H., Chuang, T. Y., &; Lee, S. W. (2010). Malposition of a Sengstaken-Blakemore Tube: A Case Report. Journal of Emergency and Critical Care Medicine, 21(4), 277-230.
Wright, G., Lewis, H., Hogan, B., Burroughs, A., Patch, D., &; O'Beirne J. (2010). A self-expanding metal stent for complicated variceal hemorrhage: experience at a single center. Gastrointestinal Endoscopy, 71(1), 71-78. doi: 10.1016/j.gie.2009.07.028
Zehetner, J., Shamiyeh, A., Wayand, W., &; Hubmann, R. (2008). Results of a new method to stop acute bleeding from esophageal varices: implantation of a self-expanding stent. Surgical Endoscopy and Other Interventional Techniques, 22(10), 2149-2152. doi: 10.1007/s00464-008-0009-7