卡维地洛联合小剂量螺内酯对曲张静脉出血的肝硬化患者再出血的预防作用  

Carvedilol combined with low-dose spironolactone in the prevention of rebleeding in cirrhotic patients with variceal bleeding

作　　者：尚华[1] 张国顺 王素颖 王志源 吴贵恺[4] 吴迪扬 王柳青 SHANG Hua;ZHANG Guo-shun;WANG Su-ying;WANG Zhi-yuan;WU Gui-kai;WU Di-yang;WANG Liu-qing(Department of Blood Purification,Tangshan Infectious Disease Hospital,Tangshan,Hebei 063000,China;不详)

机构地区：[1]唐山市传染病医院血液净化科,河北唐山063000 [2]华北理工大学附属医院消化内科,河北唐山063000 [3]华北理工大学公共卫生学院,河北唐山063000 [4]唐山市工人医院消化科,河北唐山063000 [5]唐山市弘慈医院消化科,河北唐山063000

出　　处：《中国临床研究》2021年第9期1204-1208,共5页Chinese Journal of Clinical Research

基　　金：中国肝炎防治基金会资助项目(TQGB20170015);河北省医学科学研究课题计划项目(20210375,20170933);河北省科技厅资助项目(162777133);华北理工大学研究生创新项目(2019S49,2019B30)。

摘　　要：目的探讨卡维地洛联合小剂量螺内酯对内镜下曲张静脉治疗后的肝硬化出血患者预防再出血的疗效。方法选取2016年1月至2018年1月于华北理工大学附属医院收治的确诊肝硬化食管胃底静脉曲张破裂出血并经胃镜下曲张静脉套扎、硬化治疗后的患者共100例。所选患者依据住院号随机分为观察组(卡维地洛+螺内酯组)及对照组(卡维地洛组),每组50例。对照组予以卡维地洛治疗;观察组在对照组治疗的基础上加用螺内酯治疗。观察两组患者治疗效果及再出血的发生率。结果观察组治疗效果(治愈33例,有效15例,无效2例)优于对照组(治愈20例,有效25例,无效5例),差异有统计学意义(Z=2.623,P=0.009)。观察组患者治疗后门静脉主干血流量(Q_(PV))及脾脏厚度明显低于对照组,24个月再出血发生率明显低于对照组,差异具有统计学意义(P<0.05);两组患者随访时间内再出血死亡率差异无统计学意义(P>0.05);两组患者在治疗期间乏力、头晕、心动过缓、咳嗽、低血压的发生率差异均无统计学意义(P>0.05)。结论卡维地洛联合小剂量螺内酯对内镜下曲张静脉治疗后的肝硬化出血患者能降低远期再出血风险,但对降低再出血死亡率无明显效果。Objective To investigate the clinical effect of carvedilol combined with low-dose spironolactone in the prevention of rebleeding after endoscopic variceal treatment in the cirrhotic patients with variceal bleeding.Methods A total of 100 cirrhosis patients who were diagnosed as gastric fundal variceal bleeding and treated by gastroscopic variceal ligation and sclerotherapy in the Affiliated Hospital of North China University of Technology from January 2016 to January 2018 were selected.The selected patients were divided into observation group and control group randomly(n=50,each).The control group was treated with carvedilol and the observation group was treated with spironolactone and carvedilol.The therapeutic effect and the incidence of rebleeding were observed in two groups.Results The therapeutic effect of the observation group(33 cured,15 effective,2 ineffective)was better than that of the control group(20 cured,25 effective,5 ineffective),and the difference was significant(Z=2.623,P=0.009).The portal vein main blood flow(Q_(PV))and spleen thickness in the observation group were significantly lower than those in the control group(P<0.05).The incidence of rebleeding in the observation group within 24 months was significantly lower than that in the control group(P<0.05).There was no significant difference in rebleeding mortality between the two groups(P>0.05).There was no significant difference in the incidence of fatigue,dizziness,bradycardia,cough and hypotension between the two groups(P>0.05).Conclusion Carvedilol combined with low-dose spironolactone could reduce the risk of rebleeding in patients with cirrhotic bleeding after endoscopic varicose vein treatment,but it has no significant effect on reducing the mortality of rebleeding.

关 键 词：卡维地洛 螺内酯 肝硬化 食管胃底静脉曲张出血 

分 类 号：R575.2[医药卫生—消化系统]