心得安与消心痛联用预防肝硬化食管静脉曲张破裂出血的研究

A randomized controlled study of low dose Propranolal in Combination with Isosorbide Dinitrate for Prevention of recurrent esophageal Varices bleeding

目的探讨联用小剂量心得安与消心痛预防肝硬化食管静脉曲张破裂出血（EVB）复发的疗效、副反应及其作用机制。方法在临床上对治疗组和安慰剂组患者（分别为37和35例）进行前瞻性对照研究，并用彩色多普勒超声仪监测其门脉系统血流动力学的变化。结果（1）随访2年．安慰剂组再出血率和死亡率均显著高于治疗组（P＜0．05），但两组中ChildC级肝硬化的再出血率和死亡无显著差异（P＞0.05）。（2）用药1周后治疗组Qpv、Qsv显著下降，于4周后Qpv、Qsv、Dpv、Dsv，及Vpu，均显著下降（P＜0．05～0．001），临床上亦未见明显副作用。结论联用小剂量心得安与消。心痛预防EVB复发是安全有效的．值得临床试用并加以验证。

To assess the efficacy of low dose Propranolol in Combination with Isosorbide fanitrate in theprevention of recurrent esophaged variccs bleeding in liver cirrhosis,and its act medzanism. Mettods By detecting portalSystem flow in patients with pootal hyper-tension and esophageal varices by color Doppler Flow lmaging,the therapeu-tic efficacy and safety of the thcrapy were inves-tigates. Two comparable groups of 37 and 35 cases were used. ResultsIn the follow-up period of two years,the rebleeding rate and mortality rate of the placebo group were higher than thatin the treatment group (P <0. 05 ) -but those of the patients with 1iver cirrhosis Grade C in the tow groups were no sig-nificant difference (P >0.05). After four weeks administration of the drugs,the flom of portal vein and splenic vein,thediarneter of portal veln and splcnic vein .and the velocity of portal vein in the treatment group significantly decrcased (P<0. 05~0.001 ),and no aduverse effccts was observed on the system circulation and the liver function. Conclusion lowdose propranold plus Isosorblde Dinitrate is a safe and effectve therapy in prenenting recurrent esophaged varices bleed-ing,and worth further trial.