普萘洛尔联合5-单硝酸异山梨酯对肝硬化患者门静脉血流量影响的研究

Study on propranolol plus isosorbid-5-mononitrate for portal hypertension in patients with hepatic cirrhosis

目的:观察普萘洛尔联合5-单硝酸异山梨酯对肝硬化患者门静脉血流的影响。方法:42例肝硬化门静脉高压患者,随机分为普萘洛尔组14例,5-单硝酸异山梨酯组14例,普萘洛尔与5-单硝酸异山梨酯联合组14例。分别给上述3组普萘洛尔10 mg/次,3次/d,口服;5-单硝酸异山梨酯40 mg/次,1次/d,口服;普萘洛尔10 mg/次,3次/d,5-单硝酸异山梨酯40 mg/次,1次/d,口服;疗程均为12周。于治疗前后观察门静脉系统血流动力学参数。结果:普萘洛尔组,联合组2组治疗前后门静脉血流量,脾静脉血流量均显著下降(P<0.05),5-单硝酸异山梨酯组门静脉血流量,脾静脉血流量治疗前后差异无统计学意义(P>0.05)。联合组门静脉血流量,脾静脉血流量下降幅度优于普萘洛尔组(P<0.05)。结论:普萘洛尔联合5-单硝酸异山梨酯更有效降低门静脉血流量,具有预防上消化道出血的作用。

Objective To observe the therapeutic effect of isosorbid-5-mononitrate plus propranolol on portal hypertension in patients with hepatic cirrhosis. Methods Fourty two patients with hepatic cirrhosis were divided into three groups： propranolol therapy group, isosorbid-5-mononitrate therapy group, two drugs combination therapy group, 14 cases in each group. The patients in propranolol therapy group were given propranolol 10 mg, three times a day. The isosorbid-5-mononitrate therapy group was given isosorbid-5-mononitrate 40 mg, once a day. Two drugs combination therapy group was given propranolol 10 mg, three times a day, and isosorbid-5-mononitrate 40 mg, once a day. The course of treatment was 12 weeks. The change of portal venous hemodynamics in two groups was detected before and after treatment. Results After treatment the volume of blood of portal and splenic vein in propranolol therapy group and two drugs combination therapy group decreased significantly （P 〈0.05）, while remained the same in isosorbid-5-mononitrate group （P〉0. 05）. Compared with propranolol therapy group, the volume of blood of portal and splenic vein decreased significantly in two drugs combination theray group. Conclusion Propranolol plus isosorbid-5-mononitrate can decrease the volume of blood of portal vein significantly and reduce upper gastrointestinal hemorrhagic rate.