卡维地洛联合内镜套扎术预防肝硬化伴食管静脉曲张破裂再出血的临床研究  

Clinical study of carvedilol combined with endoscopic ligation to prevent rebleeding of cirrhosis with rebleeding from ruptured esophageal varices

作　　者：唐志华 万文明 盛锦义 付玉仙 TANG Zhihua;WAN Wenming;SHENG Jinyi;FU Yuxian(Department of Gastroenterology,the First People's Hospital of Jingdezhen,Jingdezhen,Jiangxi,333000,China;Department of General Medicine,the First People's Hospital of Jingdezhen,Jingdezhen,Jiangxi,333000,China)

机构地区：[1]景德镇市第一人民医院消化内科,江西景德镇333000 [2]景德镇市第一人民医院全科医学科,江西景德镇333000

出　　处：《当代医学》2024年第36期43-46,共4页Contemporary Medicine

基　　金：景德镇市科技计划项目(20211SFZC003)。

摘　　要：目的探讨卡维地洛联合内镜套扎术预防肝硬化伴食管静脉曲张破裂再出血的临床效果。方法选取2019年2月至2022年10月景德镇市第一人民医院收治的50例肝硬化伴食管静脉曲张破裂出血患者作为研究对象,随机分为对照组与观察组,每组25例。两组均实施内镜套扎术治疗,对照组口服普萘洛尔治疗,观察组口服卡维地洛治疗。比较两组临床疗效、治疗前后静脉血液流变学指标[门静脉内径(diameter of the portal vein,DPV)、脾静脉内径(diameter of splenic vein,DSV)、脾静脉最大血流速度(splenic vein maximum velocity,SPV_(max))、门静脉最大血流速度(portal venous maximum velocity,PV_(max))]、再出血率及不良反应发生情况。结果观察组治疗总有效率为96.00%,高于对照组的68.00%,差异有统计学意义(P<0.05)。治疗后,两组DPV、DSV均短于治疗前,SPV_(max)、PV_(max)均慢于治疗前,且观察组DPV、DSV均短于对照组,SPV_(max)、PV_(max)均慢于对照组,差异有统计学意义(P<0.05)。观察组3、6、9、12个月再出血率均低于对照组,差异有统计学意义(P<0.05)。两组不良反应发生率比较差异无统计学意义。结论卡维地洛联合内镜套扎术不仅可改善肝硬化伴食管静脉曲张破裂再出血患者的静脉曲张程度,维持血液流变学稳定,还能避免再出血发生,止血效果较为理想,值得临床推广应用。Objective To explore the clinical effect of carvedilol combined with endoscopic ligation to prevent rebleeding of cirrhosis with rebleeding from ruptured esophageal varices.Methods 50 patients with cirrhosis with rebleeding from ruptured esophageal varices admitted to the First People's Hospital of Jingdezhen from February 2019 to October 2022 were selected as the study subjects,and they were randomly divided into the control group and the observation group,with 25 cases in each group.Both groups were treated with endoscopic ligation,the control group was treated with propranolol orally,and the observation group was treated with carvedilol orally.The clinical efficacy,the venous hemorheology indexes(diameter of the portal vein[DPV],diameter of splenic vein[DSV],splenic vein maximum velocity[SPV_(max)],portal venous maximum velocity[PV_(max)])before and after treatment,the rate of rebleeding and the incidence of adverse reactions were compared between the two groups.Results The total effective rate in the observation group was 96.00%,which was higher than 68.00%in the control group,and the difference was statistically significant(P<0.05).After treatment,DPV and DSV of the two groups were shorter than before treatment,and SPV_(max) and PV_(max) were slower than before treatment,while DPV and DSV in the observation group were shorter than those in the control group,SPV_(max) and PV_(max) were slower than those in the control group,and the differences were statistically significant(P<0.05).The rebleeding rate in the observation group at 3,6,9 and 12 months after discharge were lower than those in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Carvedilol combined with endoscopic ligation can not only improve the degree of varices in patients with liver cirrhosis rebleeding from ruptured esophageal variceal,maintain the stability of hemorheology,but also avoid rebleeding,hemostatic e

关 键 词：卡维地洛 内镜套扎术 肝硬化 食管静脉曲张破裂 血液流变学 

分 类 号：R57[医药卫生—消化系统]