普萘洛尔联合5-单硝酸异山梨酯对肝硬化门静脉高压血流动力学参数的影响

The effect of a combined treatment with propranolol and isosorbide-5-mononitrate on hemodynamics parameters in patients with cirrhosis and portal hypertension

目的探讨普萘洛尔联合5-单硝酸异山梨酯治疗对肝硬化门静脉高压患者血流动力学参数的影响。方法 30例肝功能Child-Pugh分级A、B级的肝硬化门静脉高压患者随机分为两组,其中普萘洛尔治疗组15例,普萘洛尔联合5-单硝酸异山梨酯治疗组15例,疗程均为48周。所有患者治疗前后均通过超声多普勒显像仪观察门静脉血流速度(VFP)和门静脉内径(PVD),并计算门静脉充血指数(PCI)。结果普萘洛尔组治疗前后VFP分别为(12.01±1.75)cm/s和(10.80±1.32)cm/s,PVD分别为(20.73±1.58)mm和(19.53±1.41)mm,差异均有统计学意义(P<0.05),PCI未显著下降(P>0.05);联合组治疗前VFP、PVD和PCI分别为(11.40±1.55)cm/s、(20.87±1.50)mm和(0.2940±0.4561),治疗后分别为(9.60±1.30)cm/s、(15.87±1.19)mm和(0.2107±0.4220),差异均有统计学意义(P均<0.05);两组比较治疗后的VFP、PVD和PCI差异均有统计学意义(P均<0.05)。结论普萘洛尔联合5-单硝酸异山梨酯较单用普萘洛尔能更有效地降低肝硬化门静脉高压血流动力学参数,具有预防上消化道出血的作用。

Objective To investigate the effect of a combined treatment with propranolol and isosorbide-5-mononitrate on hemodynamics parameters in patients with cirrhosis and portal hypertension.Methods Thirty patients with cirrhosis and portal hypertension,Child-Pugh A-B,were randomly divided into two groups.For 48 weeks,one was given propranolol and the other received combined treatment with propranolol and isosorbide-5-mononitrate.In all patients,the velocity of blood flow in the portal vein（VFP） and the cross sectional area of the portal vein（PVD） were determined with Doppler ultrasonography and the portal vein congestion index（PCI） was calculated.Results The group that received propranolol alone had a VFP of（12.01±1.75）cm/s before treatment and（10.80±1.32）cm/s afterwards and a PVD of（20.73±1.58）mm before treatment and（19.53±1.41）mm afterwards.The group that received propranolol alone had a significant decrease in VFP and PVD（P〈0.05） and slight decrease in PCI（P〈0.05）.The group that received combined treatment had a VFP of（11.40±1.55） cm/s,PVD of（20.87±1.50）mm,and PCI of（0.2940±0.4561） before treatment and a VFP of（9.60±1.30）cm/s,PVD of（15.87±1.19）mm,and PCI of（0.2107±0.4220） after treatment.All of the parameters decreased significantly for the group that received combined treatment（P〈0.05）.Conclusion Combined therapy with propranolol and isosorbide-5-mononitrate proved to be superior to therapy with propranolol alone in terms of decreasing the hemodynamic parameters in portal hypertension.Combined therapy may have had an additive effect.