三种不同方法预防肝硬化食管静脉曲张首次出血的疗效及安全性评价

发布时间：2018-06-02 23:29

本文选题：肝硬化 + 普萘洛尔　；参考：《世界华人消化杂志》2014年02期

【摘要】：目的:比较内镜下食管曲张静脉套扎术(endoscopic variceal ligation,EVL)、非选择性β受体阻滞剂普萘洛尔及两者联合应用预防肝硬化食管静脉曲张首次出血的疗效及其安全性.方法:选取食管静脉曲张有出血高危因素的肝硬化患者90例,随机分成EVL组(n=30)、药物组(n=30)和联合组(n=30),分别接受EVL、普萘洛尔及EVL+普萘洛尔治疗,观察各组患者的疗效及不良反应发生情况.结果:3组患者治疗前各指标具有可比性;平均随访时间3组无明显差异分别为19.9 mo±7.2 mo、19.3 mo±6.7 mo、21.4 mo±5.3mo(P=0.832);EVL平均套扎2.2次±1.2次,联合组平均套扎2.0次±0.9次(P0.05);药物组普萘洛尔平均剂量75.6 mg±23.4 mg,联合组平均剂量68.8 mg±30.5 mg(P0.05);3组首次静脉曲张出血率及出血相关死亡率无明显差异(10.0%,16.7%vs 6.6%,P=0.455);门脉高压性胃病发生率3组无显著差异(16.7%,6.6%vs 10.0%,P0.05);并发症及不良反应发生率差异有统计学意义(50.0%,26.7%vs 56.7%,P0.05),均未见明显严重并发症及不良反应;静脉曲张复发率(EVL组26.7%vs联合组6.6%,P=0.04),两者差异有显著性.结论:EVL、普萘洛尔及两者联合预防食管中-重度静脉曲张首次出血均有效、安全,但普洛萘尔引起的不良反应最少;EVL联合普萘洛尔在静脉曲张复发率低于单纯EVL,且不良反应不增多,但需要更大的样本量和长期的跟踪随访来进一步证实.
[Abstract]:Objective: to compare the efficacy and safety of endoscopic variceal ligation with propranolol, a non-selective 尾 receptor blocker, in the prevention of the first bleeding of esophageal varices in patients with cirrhosis. Methods: ninety patients with esophageal varices with high risk factors of bleeding were randomly divided into EVL group (n = 30) and drug group (n = 30) and combined group (n = 30). They were treated with EVL, propranolol and propranolol, respectively. The curative effect and adverse reaction were observed. Results the indexes of the three groups were comparable before treatment, the mean follow-up time of the three groups was 19.9 mo 卤7.2 motif 19.3 mo 卤6.7 motif 21.4 mo 卤5.3 mo EVL averaged 2.2 times 卤1.2 times. The average dose of propranolol was 75.6 mg 卤23.4 mg in the combined group and 68.8 mg 卤30.5 mg / g in the combined group. There was no significant difference in bleeding rate and bleeding related mortality between the three groups. There was no significant difference among the three groups (P 0.05), and there was no significant difference in the incidence of complications and side effects between the three groups (P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, P 0.05, respectively), and there was no significant difference in the incidence of complications and side effects (P 0.05). The recurrence rate of varicose veins in EVL group was significantly higher than that in EVL group (6.6% vs 0.04%). Conclusion the prevention of first bleeding of moderate to severe esophageal varices with the combination of: EVLand propranolol and both are effective and safe. However, propranolol caused the least adverse reactions. The recurrence rate of propranolol combined with propranolol in varicose veins was lower than that in simple EVLs, and the adverse reactions did not increase. However, a larger sample size and long-term follow-up were needed to further confirm the recurrence rate of propranolol in varicose veins.
【作者单位】：安徽医科大学附属安庆医院消化内科;
【分类号】：R575.2

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