糖皮质激素与解热镇痛药治疗肝硬化脾栓术后综合征的疗效比较  

Comparative study of glucocorticoids versus NSAIDS for treatment of partial splenic embolization syndrome

作　　者：于长辉[1] 黄纯炽[1] 毛华[1] 余建林[1] 

机构地区：[1]南方医科大学珠江医院消化内科,广东广州510282

出　　处：《南方医科大学学报》2013年第10期1525-1528,共4页Journal of Southern Medical University

基　　金：广东省科技计划项目(2012B031800148)

摘　　要：目的分析、对比脾栓术后综合征使用糖皮质激素或解热镇痛药的临床效果。方法选择肝硬化合并脾功能亢进术后出现脾栓术后综合征的患者共60例,所有患者均采用Seldinger技术进行部分脾动脉栓塞术。观察组30例患者术后应用地塞米松静脉注射,对照组患者口服非甾体类解热镇痛药。脾栓术后7 d观察外周血白细胞、肝功能、血白蛋白。同时还观察发热时间、腹痛时间、住院天数及是否出现上消化道出血、脾脓肿等并发症。结果观察组患者发热时间3.36±2.31 d,疼痛时间7.39±4.00 d,住院天数11.48±3.29 d,对照组发热时间5.72±3.83 d,疼痛时间9.59±4.22 d,住院天数15.07±7.93 d,观察组明显好于对照组(P<0.05)。脾栓术后7天,两组患者白细胞均较术前升高,观察组由(4.23±5.09)×109/L升至(8.49±3.53)×109/L(P<0.05),对照组由(3.21±1.33)×109/L升至(6.52±2.37)×109/L(P<0.05),但观察组术后白细胞较对照组术后白细胞升高更明显(P<0.05)。在肝功能方面(胆红素、谷丙转氨酶、谷草转氨酶、血清白蛋白)两组术前术后均无明显变化。两组均未出现上消化道出血和脾脓肿的并发症。结论脾栓术后综合征静脉应用糖皮质激素效果优于口服解热镇痛药。Objective To compare the clinical effect of glucocorticoids and NSAID in the treatment of partial splenic embolization syndrome. Methods Sixty patients with cirrhosis and spleen hyperactivity who developed partial splenic embolization syndrome after partial splenic embolization with Seldinger techmque were randomized equally into two groups to receive treatments with intravenous dexamethasone or oral nonsteroidal anti-inflammatory drugs （NSAIDs）. White blood cell counts, liver hmctions, fever duration, abdominal pain duration, hospital stay and occurrence of upper gastrointestinal hemorrhage and spleen abscess were recorded and analyzed. Results In dexamethasone group, the average fever duration, abdominal pain duration, and hospitalization days was 3.36±2.31, 7.39±4.00, and 11.48±3.29 days, respectively significantly shorter than those in NSAIDs group （5.72±3.83, 9.59±4.22, and 15.07±7.93 days, respectively, P〈0.05）. Seven days after the operation, white blood cell count （×10^9/L） significantly increased from 4.23±5.09 to 8.49±3.53 in dexamethasone group （P〈0.05）, and from 3.21±1.33 to 6.52±2.37 in NSAIDs group （P〈0.05）; the increment was more obvious in dexamethasone group （P〈0.05）. The two groups of patients showed no significant difference in liver functions after the operation. None of the patients developed upper gastrointestinal hemorrhage or spleen abscess. Conclusion Intravenous dexamethasone produces better therapeutic effect than oral NSAIDs in the management of partial splenic embolization syndrome.

关 键 词：肝硬化 部分脾动脉栓塞术 脾栓术后综合征 糖皮质激素 

分 类 号：R657.3[医药卫生—外科学]