药物治疗与内镜套扎预防肝硬化食管静脉曲张再出血的对比研究  

Porspective study on compare the efficacy of medical therapy and endoscopic varical ligation in preventing of variceal rebleeding

作　　者：陈慧婷[1] 沙卫红[1] 李瑜元[1] 聂玉强[1] 黎庆宁[1] 梁培智[1] 张龙[1] 

机构地区：[1]广州医学院附属广州市第一人民医院消化内科,510180

出　　处：《中国临床实用医学》2008年第12期81-83,共3页China Clinical Practical Medicine

摘　　要：目的比较口服普奈洛尔联合5-单硝酸异山梨醇酯与内镜套扎对肝硬化食管静脉曲张再出血的预防效果。方法2000-2005年间，146例肝硬化食管静脉曲张患者分别给予口服普奈洛尔联合5-单硝酸异山梨醇酯与内镜套扎治疗，追踪随访2年，比较两组再出血率、病死率、并发症发生率的情况。结果药物治疗组与内镜套扎组的再出血率分别为34．3％、36．2％；病死率为12．9％、15．9％，两者差别无统计学意义（P〉0．05）。并发症发生率分别为7．1％、24．6％，药物治疗组低于内镜套扎（P〈0．05）。对于肝功能较好者（Child—Pugh分级A和B）药物治疗的再出血率较内镜套扎治疗要低（11．1％／36．2％，P〈0．05）；而肝功能较差者（Child-Pugh分级C），内镜套扎治疗的再出血率较药物治疗要低（93．8％／36．4％，P〈0．05）。结论普奈洛尔联合5-单硝酸异山梨醇酯与内镜套扎相比，再出血率、病死率相当，但并发症发生率较低。对于肝功能Child-Pugh分级A和B的肝硬化患者，药物治疗能更有效的预防食管静脉曲张再出血；而肝功能Child—Pugh分级C的患者，内镜套扎治疗更有效。Objective To comparison the efficacy of medical therapy （propranolol plue Isosorbide-5- mononitrate（ISMN） and endoscopic varical ligation（EVL） in preventing of variceal rebleeding. Methods 146 patients were randomized treated with medicament and EVL,and followed up in two years. Compare two groups in rebleeding, complications and mortality. Results In medical therapy group, 34. 3 % patients were rebleeding, complications and mortality were 7.1% and 12. 9% ;in EVL group were 36. 2% ,24. 6% and 15.9%. Conclusion Compared with EVL,medical therapy reduces complications but has no effection on rebleeding and mortality in hepatic cirrhosis patients who had variceal bleeding before. By subgrading analysis, medical therapy could significantly reduce the risk rebleeding for patients with Child-Pugh A and B. But for patients with Child- Pugh C,is reverse.

关 键 词：内镜套扎 普奈洛尔 5-单硝酸异山梨醇酯 食管静脉曲张 再出血 

分 类 号：R575.2[医药卫生—消化系统]