内镜下套扎联合普萘洛尔对肝硬化上消化道出血患者血流动力学影响以及疗效分析

Effect of EVL combined with propranolol on hemodynamics in patients with liver cirrhosis and upper gastrointestinal bleeding and its curative effect

[目的]观察内镜下静脉曲张套扎术(EVL)联合普萘洛尔对肝硬化上消化道出血患者血流动力学的影响,并分析其临床疗效。[方法]选取2015年3月~2017年4月我院急诊科收治的肝硬化伴发上消化道出血患者152例,使用数字表法将152例患者随机分为对照组和观察组,每组76例。对照组经利多卡因局部麻醉后行EVL,观察组在对照组的基础上加用普萘洛尔。[结果]2组的止血时间比较差异无统计学意义(P>0.05),但观察组的住院时间显著低于对照组[(10.15±1.67)d vs.(12.73±2.82)d,P<0.05]。2组术后胸痛的发生率差异无统计学意义(P>0.05),观察组术后发热和院内感染的发生率分别为11.84%和6.58%,显著低于对照组的27.63%和18.42%(P<0.05)。2组术后近期再出血的发生率差异无统计学意义(P>0.05),但观察组术后远期再出血发生率为显著低于对照组(9.21%vs.21.05%,P<0.05)。治疗后观察组门静脉和脾静脉的血流量显著低于对照组(P<0.05)。[结论]内镜下套扎联合普萘洛尔可改善肝硬化上消化道出血患者的血流动力学,降低发热、感染和远期再出血发生率,有利于患者术后恢复。

[Objective]To detect the effect of endoscopic variceal ligation（EVL）combined with propranolol on hemodynamics in patients with liver cirrhosis and upper gastrointestinal bleeding and its curative effect.[Methods]A total of 152 patients with liver cirrhosis and upper gastrointestinal bleeding were enrolled in this study.Patients were randomly divided into control group（n=76）and observation group（n=76）.In control group,EVL was performed after lidocaine local anesthesia,and the observation group was added with propranolol on the basis of EVL.[Results]There was no significant difference in the time of hemostasis in the two groups（P〉0.05）.The hospitalization time in observation group was（10.15±1.67）d,which was significantly lower than that of（12.73±2.82）d in control group（P〈0.05）.There was no significant difference in the incidence of chest pain between the two groups（P〉0.05）.The incidence of postoperative fever and nosocomial infection in observation group was 11.84% and 6.58%,which was significantly lower than that of 27.63%and 18.42%in control group（P〈0.05）.There was no significant difference in the incidence of recent rebleeding between the two groups（P〉0.05）.The rate of long-term rebleeding in observation group was 9.21%,which was significantly lower than that of 21.05% in control group（P〈0.05）.After treatment,the blood flow of portal vein and splenic vein in observation group was significantly lower than that in control group（P〈0.05）.[Conclusion]ELV combined with propranolol canimprove hemodynamics and reduce fever,infection and long-term rebleeding rate in patients with liver cirrhosis and upper gastrointestinal bleeding,which is conducive to postoperative recovery.