肝硬化食管胃静脉曲张普萘洛尔干预后血流动力学应答及无应答患者的特征分析

Characteristics of esophagogastric varices patients with and without hemodynamic response after the intervention of propranolol

目的研究肝硬化食管胃底静脉曲张经普萘洛尔干预后血流动力学应答及无应答患者的临床特征。方法纳入我院102例肝硬化食管胃底静脉曲张患者为对象,分别于普萘洛尔口服前和服药7d后行肝静脉压力梯度测定,对成功完成2次测定者展开随访,分析普萘洛尔耐受性、血流动力学应答状况及出血情况。结果102例患者最终纳入研究分析的共96例,血流动力学应答率占43.75%。应答者普萘洛尔短期服用后第2次心率、肝静脉楔压、肝静脉压力梯度显著低于服药前(P<0.05),无应答者第2次心率、肝静脉压力梯度显著低于服药前(P<0.05)。应答者第2次肝静脉压力梯度显著低于无应答者(P<0.05)。随访3年发现食管胃底静脉曲张破裂出血发生率占25.00%。血流动力学应答者食管胃底静脉曲张破裂出血未发生率为100%,显著高于无应答者的44.44%(P<0.05)。结论肝硬化食管胃底静脉曲张患者服用普萘洛尔短期后会出现血流动力学应答,而无应答者食管胃底静脉曲张破裂出血风险较应答者高。

Objective To study the hemodynamic response and clinical characteristics of patients with esophageal and gastric varices after the intervention of propranolol.Methods There were 102 cirrhotic patients with esophagogastric varices in our hospital undergoing the measurement of hepatic vein pressure gradient before and 7 days after the administration of propranolol.The patients who successfully completed the 2 tests were followed up to analyze the tolerance of propranolol,hemodynamic status and bleeding.Results There were 96 of 102 patients finally included in the study,and the hemodynamic response rate accounted for 43.75%.In responders,the heart rate,wedged hepatic venous pressure and hepatic venous pressure gradient after short-term administration of propranolol were significantly lower than those before administration(P<0.05).In non-responders,the heart rate and hepatic venous pressure gradient after administration were significantly lower than those before administration(P<0.05).The post-treatment hepatic vein pressure gradient of the responders was significantly lower than that of the non-responders(P<0.05).During the follow-up of 3 years,the incidence of esophageal and gastric variceal bleeding in the whole cohort was 25.00%.The incidence of bleeding in responders was 0,significantly lower than 55.56%in non-responders(P<0.05).Conclusion Patients with cirrhotic esophagogastric varices who received propranolol for a short period of time were probable to have a hemodynamic response.And those with no hemodynamics response had a higher risk of bleeding than responders.