内镜下套扎联合卡维地洛治疗食管静脉曲张再出血的临床效果

Clinical effect of endoscopic ligation combined with carvedilol in the treatment of esophageal varices rebleeding

目的观察内镜下套扎联合卡维地洛治疗食管静脉曲张再出血的临床效果。方法选取2017年8月至2020年8月我院收治的90例食管静脉曲张再出血患者,根据治疗方式将其分为对照组(45例,内镜下套扎)和观察组(45例,内镜下套扎+卡维地洛)。比较两组的食管静脉曲张程度、血流动力学指标、血管内皮损伤指标及预后情况。结果术前,两组的食管静脉曲张程度比较,差异无统计学意义(P>0.05);术后半年,两组的食管静脉曲张程度均减轻,且观察组优于对照组,差异具有统计学意义(P<0.05)。术前,两组的血小板计数、脾脏厚度、门静脉内径、血流量比较,差异无统计学意义(P>0.05);术后半年,两组的血小板计数、血流量均增大,脾脏厚度、门静脉内径均减小,且观察组优于对照组(P<0.05)。术前,两组的NO、ET-1、UⅡ水平比较,差异无统计学意义(P>0.05);术后半年,两组NO、ET-1水平均降低,UⅡ水平均升高,且观察组优于对照组(P<0.05)。观察组的术后半年再出血率低于对照组,差异具有统计学意义(P<0.05)。术前,两组的Child-Pugh评分比较,差异无统计学意义(P>0.05);术后半年,两组的Child-Pugh评分均降低,且观察组低于对照组,差异具有统计学意义(P<0.05)。结论内镜下套扎联合卡维地洛治疗食管静脉曲张再出血的临床效果显著,可改善食管静脉曲张程度及血流动力学指标,减小脾脏厚度及血管损伤,降低再出血率,进而提高患者的预后效果,值得临床推广和应用。

Objective To observe the clinical effect of endoscopic ligation combined with carvedilol in the treatment of esophageal varices rebleeding.Methods A total of 90 patients with esophageal varices rebleeding who were treated in our hospital from August 2017 to August 2020 were selected and divided into control group(45 cases,endoscopic ligation)and observation group(45 cases,endoscopic ligation + carvedilol) according to the treatment method.The degree of esophageal varices,hemodynamic indexes,vascular endothelial injury indexes and prognosis were compared between the two groups.Results Before surgery,there was no significant difference in the degree of esophageal varices between the two groups(P>0.05);half a year after operation,the degree of esophageal varices in both groups relieved,that in the observation group was better than the control group,and the difference was statistically significant(P<0.05).Before operation,there were no significant difference in platelet count,spleen thickness,portal vein diameter and blood flow between the two groups(P>0.05);half a year after operation,platelet count and blood flow in both groups increased,spleen thickness and portal vein diameter decreased,and those in the observation group were better than the control group(P <0.05).Before operation,there was no significant difference in the levels of NO,ET-1 and UⅡ between the two groups(P>0.05);half a year after operation,the levels of NO and ET-1 in both groups decreased,while the level of U Ⅱ increased,and those in the observation group were better than the control group(P<0.05).The rebleeding rate in the observation group in half a year after operation was lower than that in the control group,and the difference was statistically significant(P<0.05).Before operation,there was no significant difference in the Child-Pugh score between the two groups(P>0.05);half a year after the operation,the Child-Pugh score in the two groups decreased,that in the observation group was lower than the control group,and the difference was statistically significant(P<0.05).Conclusion Endoscopic ligation combined with carvedilol in the treatment of esophageal varices rebleeding has a significant clinical effect,which can improve the degree of esophageal varices and hemodynamics,decrease spleen thickness and vascular damage,reduce rebleeding rate,and improve the patients’ prognostic effect,which is worthy of clinical application and promotion.