NSBB在预防食管静脉曲张内镜套扎术后早期再出血的意义

Significance of NSBB in preventing earlier rehaemorrhagia after endoscopic ligation of the patients with esophageal varices

目的探讨非选择性β受体阻滞剂（NSBB）卡维地洛在食管静脉曲张内镜套扎术后预防早期再次出血的价值。方法前瞻性分析2011年5月至2014年8月于我院住院行内镜套扎手术治疗的90例食管静脉曲张破裂出血的肝硬化患者的临床资料。根据治疗方案的不同,将入选者随机分为观察组（46例）和对照组（44例）,其中对照组实施内镜套扎的治疗方案,观察组在对照组基础上添加药物卡维地洛。比较两组患者的基线资料、病情及手术相关指标、治疗前后肝功能指标、疗效及不良反应。结果治疗前两组患者的肝功能相关指标比较差异无统计学意义（P〉0.05）,而治疗2周后观察组患者的TBIL（t=2.046,P=0.044）、AKP（t=4.945,P〈0.01）、HVPG（t=5.486,P〈0.01）水平均低于对照组,而Hb（t=3.774,P〈0.01）、Alb（t=5.853,P〈0.01）水平高于对照组;治疗后观察组患者的食管静脉Grade分级（χ~2=8.130,P=0.017）、早期再次出血率（χ~2=4.304,P=0.038）和死亡率（χ~2=4.358,P=0.037）均低于对照组,差异有统计学意义（P〈0.05）。结论卡维地洛能够改善食管静脉曲张患者肝功能,降低门脉压力,进而预防内镜套扎术后早期再出血。

Objective To discuss the value of non-selective beta blockers（NSBB） in preventing earlier rehaemorrhagia after endoscopic ligation of the patients with esophageal varices.Methods Clinical data of 90 cirrhosis patients with esophageal varices rupture and bleeding received treatment of endoscopic ligation in our hospital from May2011 to August 2014 was prospectively analyzed.Patients were divided into two groups according to the treatment,observe group（n=46） and control group（n =44）.Patients in control group were treated by endoscopic ligation,and patients in observe group were added carvedilol on the basis of the control group.The general information,illness condition,operation related indexes,liver function indexes before and after treatment,curative effect and untoward effect were compared.Results There was no significant difference in liver function indexes before treatment（P〈0.05）.The levels of TBIL（t =2.046,P=0.044）,AKP（t =4.945,P〈0.01）,HVPG（t = 5.486,P〈0.01） of patients in observe group at 2 weeks after treatment were lower than those in control group,and the levels of Hb（t =3.774,P〈0.01）,Alb（t =5.853,P〈0.01） in observe group were higher than those in control group,the differences were significant（P〈0.05）.The esophageal vein grade（χ~2 = 8.130,P = 0.017）,the early rebleeding rate（χ~2 = 4.304,P =0.038） and the death rate（χ~2 =4.358,P=0.037） of patients in observe group were all lower than those in control group.Conclusion Carvedilol can prevent earlier rehaemorrhagia after endoscopic ligation by improving the liver function of patients with esophageal varices and reducing portal pressure.