卡维地洛联合内镜套扎术预防食管静脉曲张再次出血的疗效及安全性分析

Efficacy and safety of carvedilol plus endoscopic variceal ligation for secondly prophylaxis of variceal bleeding in cirrhotic patients

目的比较卡维地洛联合内镜套扎术(EVL)与普萘洛尔联合EVL预防肝硬化患者食管静脉曲张再次出血的疗效及安全性。方法选择首次食管静脉曲张破裂出血的肝硬化患者60例,随机分成治疗组(n=30)和对照组(n=30),两组均接受EVL治疗。其中,治疗组口服卡维地洛,对照组口服普萘洛尔治疗。观察两组患者的疗效及不良反应。结果卡维地洛平均使用剂量为(17.4±5.8)mg/d,普萘洛尔平均使用剂量为(96.6±19.8)mg/d,治疗组总出血率为20.0%;对照组总出血率为30.0%,两组总出血率差异有显著性(P<0.05)。治疗组死亡率为13.3%,与对照组死亡率(16.7%)比较差异有显著性(P<0.05)。总共有35例患者出现了不良反应(58.3%),但两组的不良反应发生率无明显差异(P>0.05)。结论卡维地洛联合内镜套扎术能较好降低食管静脉曲张再出血率和死亡率,且不良反应率低。

【Objective】To compare the efficacy and safety of carvedilol plus endoscopic variceal ligation（EVL）with propranolol plus EVL for the secondly prophylaxis of variceal bleeding in cirrhotic patients. 【Methods】Sixty patients with cirrhosis and first esophageal variceal bleeding were randomly divided into two groups, treatment group（n =30） and control group（n =30）. Treatment effectiveness and side effects in the two groups were compared.【Results】Mean daily carvedilol dose in treatment group was（17.4±5.8） mg/d, and propranolol dose in control group was（96.6±19.8） mg/d. The rate of rebleeding（20% vs. 30%, P〈0.05）） and mortality（13.3% vs. 16.7%, P〈0.05） was significantly different between the two groups. Side effects occurred in 35 patients（58.3%）, but the difference in side effects between the two groups was not significant（P〉0.05）.【Conclusion】Carvedilol plus endoscopic variceal ligation are effective and safe in secondly prophylaxis of variceal bleeding in cirrhotic patients.