心得安、硬化剂及两者联合预防食管胃底静脉曲张再出血的研究

The study on propranolol,scleroinjection and the combination of two methods for preventing rebleeding on esophageal and gastric varical bleeding

目的比较心得安、硬化剂及两者联合预防食管胃底静脉曲张再出血的临床疗效。方法115例食管胃底静脉曲张破裂出血患者,随机分为三组,其中接受心得安治疗40例,硬化剂治疗35例,硬化剂联合心得安治疗40例,比较三组患者3个月、6个月、1年、2年不同时间段的再出血率、死亡率和并发症情况。结果3个月和6个月内三组患者再出血率比较,差异均无统计学意义(P>0.05);1年和2年内硬化剂联合心得安组再出血率均低于心得安组,差异有统计学意义(P<0.05);1年内硬化剂组与心得安组的再出血率无明显差异(P>0.05),而2年内硬化剂组再出血率低于心得安组,差异有统计学意义(P<0.05),三组患者的死亡率和并发症比较,无明显差异(P>0.05)。结论硬化剂联合心得安预防再出血疗效最好,硬化剂次之,心得安最差。

Objective To evaluate the efficacy of treatment with propranolol, scleroinjection and the combination of two methods for preventing rebleeding on esophageal and gastric varical bleeding. Methods One hundred and fifteen patients with esophageal and gastric varical bleeding were randomly divided into three groups. There were forty patients treated with propranolol, thirty-five patients treated with scleroinjection and forty patients treated wih the combination of two methods. The rebleeding rate, death rate and complication rate among the three groups were compared in 3 months, 6 months, 1 year, 2 years. Results There was no significant difference in rebleeding rate among the three groups in 3 months or 6 months ;but the rebleeding rate in the group treated with the combination of two methods was lower than that in the group treated with only propranolol in 1 year and 2 years （P 〈 0.05 ）. There was no significant difference in rebleeding rate between the group treated with scleroinjection and the group treated with propranolol in 1 year （P 〉 0.05 ） ; but the rebleeding rate in the group treated with scleroinjection was lower than that in the group treated with propranolol in 2 years （P 〈 0.05）. There was no significant difference in death rate and complication rate among three groups （P 〉 0.05）. Conclusion The efficacy of preventing rebleeding which treated with the combination of two methods is the best, seleroinjection is the second, propranolol is the last.