卡维地洛与普萘洛尔联合奥曲肽对肝硬化并发上消化道出血的疗效比较  

Comparison of efficacy of carvedilol and propranolol combined with octreotide on upper gastrointestinal hemorrhage in patients with liver cirrhosis

作　　者：李荣萍 汪兴伟 唐浩 Li Rongping;Wang Xingwei;Tang Hao(Department of Emergency,No.928 Hospital of Joint Logistic Support Forces of PLA,Haikou 571159,China)

机构地区：[1]联勤保障部队第九二八医院急诊科,海南海口571159 [2]联勤保障部队第九二八医院肝胆外科,海南海口571159 [3]陆军特色医学中心消化内科

出　　处：《海军医学杂志》2024年第10期1100-1103,共4页Journal of Navy Medicine

摘　　要：目的比较卡维地洛与普萘洛尔联合奥曲肽对肝硬化并发上消化道出血的疗效。方法选取2020年1月至2022年1月联勤保障部队第九二八医院收治的肝硬化并发上消化道出血患者72例作为研究对象,采用随机数字表法随机分为对照组和观察组各36例。对照组采用普萘洛尔联合奥曲肽治疗,观察组采用卡维地洛联合奥曲肽治疗。比较2组治疗前后门静脉血流量、脾静脉血流量、肝静脉楔入压(WHVP)、肝静脉游离压(FHVP)和肝静脉压力梯度(HVPG)。比较2组疗效、48 h再出血率、住院时间和不良反应发生情况。结果观察组总有效率高于对照组(P<0.05)。2组48 h再出血率和住院时间比较差异无统计学意义(P>0.05)。2组治疗前的静脉血流量、脾静脉血流量、WHVP、FHVP和HVPG比较差异无统计学意义(P>0.05);治疗后观察组静脉血流量、脾静脉血流量、WHVP和HVPG均低于对照组(P<0.05),2组FHVP比较差异无统计学意义(P>0.05)。治疗期间2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论卡维地洛联合奥曲肽对肝硬化并发上消化道出血的疗效优于普萘洛尔联合奥曲肽,在降低HVPG、改善门静脉和脾静脉的血流量方面效果更佳,且安全性良好,值得在临床推广使用。Objective To compare the efficacy of carvedilol and propranolol combined with octreotide in the treatment of upper gastrointestinal hemorrhage in patients with liver cirrhosis.Methods A total of 72 patients with liver cirrhosis and upper gastrointestinal hemorrhage who were admitted to No.928 Hospital of Joint Logistic Support Forces of PLA from January 2020 to January 2022 were selected as research objects.The patients were divided into control group and observation group by random number table method,with 36 patients in each group.The control group was treated with propranolol and octreotide,and the observation group was treated with carvedilol and octreotide.Portal vein blood flow,splenic vein blood flow,hepatic venous wedge pressure(WHVP),hepatic venous free pressure(FHVP),and hepatic venous pressure gradient(HVPG)were recorded before and after treatment.The treatment efficacy,rebleeding rate within 48 h,length of hospital stay and adverse reactions were compared between the two groups.Results The total effective rate of treatment in the observation group was significantly higher than that in the control group(P<0.05).There was no significant difference in the rebleeding rate within 48 h,the length of hospital stay,or the incidence of adverse reactions between the two groups(P>0.05).There was no significant difference in the portal venous blood flow,splenic venous blood flow,WHVP,FHVP,or HVPG between the two groups before treatment(P>0.05).The portal venous blood flow,splenic venous blood flow,WHVP,and HVPG in the observation group were significantly lower than those in the control group after treatment(P<0.05),while there was no significant difference in the FHVP between the two groups(P>0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05)Conclusion Carvedilol combined with octreotide is more effective in treating upper gastrointestinal hemorrhage in patients with liver cirrhosis than propranolol combined with octreotide.It can significantly red

关 键 词：肝硬化 急性上消化道大出血 卡维地洛 普萘洛尔 奥曲肽 

分 类 号：R575[医药卫生—消化系统]