卡维地洛预防食管静脉曲张内镜治疗后再出血的临床应用研究

发布时间：2018-03-22 16:03

本文选题：卡维地洛　切入点：食管静脉曲张　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:肝硬化食管静脉曲张破裂出血的患者内镜下治疗基础上,分别联合卡维地洛以及不联合非选择性β受体阻滞剂,比较其再出血率、生存率、肝静脉压力梯度(HVPG)的变化,从而研究卡维地洛在肝硬化食管静脉曲张出血的二级预防中的临床意义,为临床上治疗肝硬化食管静脉曲张出血提供科学参考依据。研究方法:回顾性分析从2010年1月至2016年1月于山东大学附属省立医院(东院区)住院的375例肝硬化食管静脉曲张破裂出血的患者,共筛选出符合条件的研究对象93人,其中随访资料齐全的82人。其中内镜联合卡维地洛治疗组50例(随访资料齐全42例),单纯内镜治疗组43例(随访资料齐全40例),两组的主要研究终点均为再出血时间,次要终点为死亡时间。统计两组的信息,并经过随访,收集患者接受治疗后至2017年3月15日的基本状况,包括:再出血时间,药物不良反应,追加治疗,死亡时间和原因等,并比较内镜联合卡维地洛治疗组经药物治疗后肝静脉压力梯度(HVPG)的变化。统计两组的再出血率和生存率,以及内镜联合卡维地洛治疗组患者出现的药物不良反应和不耐受患者的比例。应用统计软件SPSS19.0进行相关数据的分析。结果内镜联合卡维地洛治疗组患者治疗前的HVPG为14.26±5.88mmHg,经治疗后下降至12.92±6.76mmHg,差异有统计学意义(t=2.504,P=0.019)。两组患者随访时间分别为(36.85±20.04)个和(29.32± 15.82)个月,随访期间出现再出血的人数为43人,其中内镜联合卡维地洛治疗组20人,单纯内镜治疗组23人。内镜联合卡维地洛治疗组和单纯内镜治疗组三年内总再出血率为42.86%和57.5%,差异有统计学意义。内镜联合卡维地洛治疗组和单纯内镜治疗组治疗后1年、2年、3年累计未再出血率分别为(73.2%,58.3%,50.7%)vs(70.0%,48.7%,39.0%),内镜联合卡维地洛治疗组高于单纯内镜治疗组,有统计学意义(Log rank检验,卡方=4.039,P=0.044)。两组3年内死亡人数分别为1人和5人,死亡率分别为2.38%和12.5%,内镜联合卡维地洛治疗组低于单纯内镜治疗组,但无明显统计学上的差异(P=0.09)。内镜联合卡维地洛治疗组患者用药后,有出现体位性低血压(7.14%),心动过缓(4.76%),头晕(7.14%),因药物不良反应减少用药量的患者占2.38%,严重者因不耐受而换药或者停药(4.76%),但和未使用药物的患者相比,经统计学检验,未见显著差异(P0.05)。结论:1.卡维地洛可明显降低食管静脉曲张出血患者的肝静脉压力梯度,从而降低再出血的风险;2.卡维地洛可明显降低食管静脉曲张出血患者的再出血率,延长患者未再出血时间。
[Abstract]:Objective: to compare the rebleeding rate and survival rate with carvedilol and non-selective 尾 receptor blockers on the basis of endoscopic treatment in patients with esophageal variceal hemorrhage due to cirrhosis. To study the clinical significance of carvedilol in the secondary prevention of esophageal variceal hemorrhage due to cirrhosis. Methods: from January 2010 to January 2016, 375 patients with cirrhosis of the liver were hospitalized in Shandong University Provincial Hospital (Eastern Hospital) from January 2010 to January 2016. Patients with esophageal variceal bleeding, A total of 93 eligible subjects were selected. Among them, 82 cases were followed-up, 50 cases were treated by endoscopy combined with carvedilol (42 cases were followed-up, 43 cases were treated with endoscopy alone), 40 cases were followed-up, the main endpoints of both groups were rebleeding time. The secondary endpoints were the time of death. The information of the two groups was counted and followed up. The basic condition of the patients was collected after receiving treatment until March 15, 2017, including: time of rebleeding, adverse drug reactions, supplementary treatment, time of death and cause of death, etc. The changes of hepatic vein pressure gradient (HVPGs) in the endoscopic and carvedilol treated group were compared. The rebleeding rate and survival rate of the two groups were analyzed. And the proportion of adverse drug reactions and intolerance in the endoscopic combined carvedilol group. Statistical software SPSS19.0 was used to analyze the related data. Results the patients in the endoscopic combined carvedilol group before treatment. The HVPG was 14.26 卤5.88 mm Hg, decreased to 12.92 卤6.76 mmHg after treatment, the difference was statistically significant (2.504 卤0.019). The follow-up time of the two groups was 36.85 卤20.04 and 29.32 卤15.82 months, respectively. The number of patients with rebleeding during follow-up was 43, including 20 in the endoscopic combined carvedilol group. The total rate of rebleeding in the endoscopic combined with carvedilol group and the simple endoscopic treatment group was 42.86% and 57.5% in three years, the difference was statistically significant. The endoscopic combined carvedilol treatment group and the simple endoscopic treatment group were treated with the total bleeding rate of 42.86% and 57.5% respectively. The accumulative rate of no further bleeding was 73.2% and 58.3%, respectively, one year, two years and three years after the treatment. The accumulative rate of no bleeding was 50.7 / 58.3 and 50.7 / 48.7 / 70.00.The endoscopic combined carvedilol treatment group was higher than the simple endoscopic treatment group. There were significant differences between the two groups in terms of the number of deaths within 3 years (1 person and 5 cases), the mortality rates were 2.38% and 12.5%, respectively. The rate of death in the treatment group of endoscopy combined with carvedilol was lower than that in the group treated with endoscopy alone. However, there was no significant statistical difference between the two groups. There were cases of postural hypotension of 7.14m, bradycardia of 4.76a, dizziness of 7.14m, reduction of drug dosage due to adverse drug reactions (2.38%), and severe patients changing or stopping medicine 4.76g because of intolerance. However, compared with patients who did not use drugs, they underwent statistical tests. Conclusion: 1. Carvedilol can significantly reduce the pressure gradient of hepatic vein in patients with esophageal variceal bleeding, and thus reduce the risk of rebleeding 2.Carvedilol can significantly reduce the rate of rebleeding in patients with esophageal variceal hemorrhage. The time of no further bleeding was prolonged.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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