内镜下套扎联合药物注射治疗肝硬化合并上消化道出血的疗效

Analysis of the curative effect of endoscopic band ligation combined with drug injection in the treatment of hepatic cirrhosis complicated with upper gastrointestinal haemorrhage

目的:探讨内镜下套扎联合药物注射治疗肝硬化合并上消化出血的疗效。方法:随机双盲法将76例肝硬化合并上消化道出血患者分为2组各38例,对照组采取单纯保守方案治疗,实验组则在对照组基础上行内镜下套扎联合药物注射治疗,比较2组止血时间、住院时间、再出血及治疗前后血流动力学等指标。结果:实验组再出血率、发热发生率分别为2.6%、10.5%,较对照组的21.1%、28.9%差异有统计学意义(P<0.05)。实验组与对照组在输血量、止血时间、症状改善时间及住院时间方面比较差异有统计学意义(P<0.01)。实验组治疗后门静脉血流量、脾静脉血流量均显著少于对照组,差异有统计学意义(P<0.05)。结论:内镜下套扎联合药物注射治疗肝硬化合并上消化出血疗效明确,能明显改善患者静脉曲张血流动力学,再出血率低。

Objective To explore the curative effects of endoscopic band ligation combined with drug injection in the treatment of hepatic cirrhosis complicated with upper gastrointestinal hemorrhage. Methods 76 patients with hepatic cirrhosis complicated with upper gastrointestinal hemorrhage were divided into 2 groups by random double blind method, with 38 cases in each group. The control group were treated by conservative regimen alone while the experimental group were treated by endoscopic band ligation combined with drug injection, based on the control group. The clinical curative effects, adverse reactions, hemostasis time, hospitalization time , rebleeding , haemodynamics and other indexes before and after the treatment in the 2 groups were compared. Results The total effective rate, rebleeding rate and the incidence of fever in the experimental group were 2.6% and 10.5%, respectively. Compared with those in the control group （71.1%, 21.1%, 28.9%）, the differences were statistically significant （P 〈 0.05）. The differences in volume of blood transfusion, hemostasis time , time of improvement of symptoms and hospitalization time between the experimental group and the control group were significant （P 〈 0.01）. The blood flow of portal vein（550.2 ± 143.4）mL and splenic vein （284.3 ± 96.4）mLin the experimental group was significantly less than that in the control group [（628.1 ± 156.0）mL, （332.6 ± 100.3）mL] （P 〈 0.05）. Condusions Endoscopic band ligation combined with drug injection in the treatment of hepatic cirrhosis complicated with upper gastrointestinal hemorrhage is effective and can significantly improve the varicose hemodynamics in patients. The rate of rebleeding is low.