肝硬化门静脉高压食管胃静脉曲张出血的预防治疗研究

Research on prevention and treatment of cirrhotic portal hypertension esophageal variceal bleeding

目的探讨肝硬化门静脉高压食管胃静脉曲张出血的预防治疗效果。方法选取本院2015年9月~2017年9月诊治的肝硬化门静脉高压食管胃静脉曲张患者90例,采用随机数字表法分为两组,对照组患者45例采用普萘洛尔治疗,观察组患者45例采用卡维地洛治疗,比较两组患者的出血风险。结果治疗前两组患者肝肾功能(总胆红素、肌酐、白蛋白、肝静脉压力梯度)比较,差异无统计学意义(P> 0.05)。治疗前后分析,两组患者肝肾功能(总胆红素、肌酐、白蛋白)比较,差异无统计学意义(P> 0.05);两组患者肝肾功能(肝静脉压力梯度)显著降低,差异有统计学意义(P <0.05)。治疗后分析,两组患者肝肾功能(总胆红素、肌酐、白蛋白)比较,差异无统计学意义(P> 0.05);观察组患者肝肾功能(肝静脉压力梯度)低于对照组(P <0.05)。观察组患者用药3、6、9、12个月出血风险低于对照组(P <0.05)。两组患者用药不良反应(腹痛、气短、嗜睡)比较,差异无统计学意义(P> 0.05)。结论卡维地洛可降低肝硬化门静脉高压食管胃静脉曲张患者的出血风险。

Objective To explore the prevention and treatment effect of cirrhotic portal hypertension esophageal variceal bleeding. Methods 90 patients with cirrhotic portal hypertension esophageal variceal bleeding who were diagnosed and treated in our hospital from September 2015 to September 2017 were selected. According to random number table method, they were divided into two groups. 45 patients in the control group were treated with propranolol while 45 patients in the observation group were treated with carvedilol. The risk of bleeding was compared between the two groups. Results Before treatment, there was no statistically significant difference in liver and kidney function(total bilirubin, creatinine, albumin, hepatic vein pressure gradient) between two groups(P > 0.05). There was no statistically significant difference in liver and kidney function(total bilirubin, creatinine, albumin) before and after treatment between the two groups(P > 0.05). Liver and kidney function(hepatic venous pressure gradient) was significantly decreased in the two groups, and the difference was statistically significant(P < 0.05). After treatment,there was no statistically significant difference in liver and kidney function(total bilirubin, creatinine, albumin)between the two groups(P > 0.05). The liver and kidney function(hepatic venous pressure gradient) of the observation group was lower than that of the control group(P < 0.05). The risk of bleeding in the observation group was lower than that of the control group at 3, 6, 9 and 12 months of medication(P < 0.05). There were no statistically significant differences in adverse drug reactions(abdominal pain, shortness of breath and sleepiness) between the two groups(P > 0.05). Conclusion Carvedilol can reduce the risk of bleeding in patients with cirrhotic portal hypertension esophageal varices.