活血化瘀通络法治疗肝硬化合并上消化道出血肝脾血瘀证的临床观察

Clinical observation on the treatment of liver cirrhosis complicated with upper gastrointestinal hemorrhage with blood stasis in liver and spleen syndrome by promoting blood circulation,removing blood stasis and dredging collaterals

目的:探究活血化瘀通络法治疗肝硬化合并上消化道出血肝脾血瘀证的效果。方法:按随机数字表法将2018年3月—2021年4月于洛阳新区人民医院消化内科就诊的76例肝硬化合并上消化道出血肝脾血瘀证患者分为2组,每组38例。对照组患者采用生长抑素联合垂体后叶素注射液治疗,研究组在对照组治疗基础上加用活血化瘀通络法治疗。比较两组患者临床疗效、中医证候积分、治疗情况、血流动力学指标的变化及不良反应情况。结果:研究组治疗总有效率高于对照组(P<0.05);治疗后与对照组比较,研究组患者胁痛如刺、朱砂掌、肝或脾肿大、肋胁久痛、面色晦暗等症状积分降低,平均止血时间缩短,平均输血量减少,门静脉及脾静脉内径缩小,门静脉及脾静脉血流量减少(P<0.01)。两组患者治疗期间均未见明显不良反应。结论:肝硬化合并上消化道出血肝脾血瘀证患者应用活血化瘀通络法治疗获得较好的临床效果,临床症状均得到有效改善,短时间内便可有效止血,输血量较少,且血流动力学指标改善明显,无明显不良反应,安全可靠。

Objective:To explore the therapeutic effect of promoting blood circulation,removing blood stasis and dredging collaterals on liver cirrhosis complicated with upper gastrointestinal hemorrhage with blood stasis in liver and spleen syndrome.Methods:According to the random number table method,76 patients with liver cirrhosis complicated with upper gastrointestinal hemorrhage with blood stasis in liver and spleen syndrome who were treated in the Department of Gastroenterology of Luoyang New District People′s Hospital from March 2018 to April 2021 were divided into 2 groups with 38 cases in each group.The patients in the control group were treated with somatostatin combined with pituitrin injection,and the patients in the study group were treated by promoting blood circulation,removing blood stasis and dredging collaterals on the treatment basis of the control group.The clinical efficacy,TCM syndrome score,treatment status,hemodynamic index changes and adverse reactions were compared between the two groups.Results:The total effective rate of the study group was higher than that of the control group(P<0.05).After treatment,compared with the control group,the scores of hypochondriac prickling pain,cinnabar palm,liver or spleen enlargement,chronic pain in the ribs,dark face and other symptoms were decreased in the study group,the average hemostatic time was shortened,the average blood transfusion volume was decreased,the internal diameters of the portal vein and spleen vein were reduced,and the blood flow of the portal vein and spleen vein were decreased(P<0.01).No obvious adverse reactions were observed in both groups during treatment.Conclusion:The application of promoting blood circulation,removing blood stasis and dredging collaterals method in the treatment of liver cirrhosis complicated with upper gastrointestinal hemorrhage with blood stasis in liver and spleen syndrome can achieve good clinical effect,effectively improve the clinical symptoms,and effectively stop bleeding in a short time,with less blood transfusion.The hemodynamic indexes are significantly improved,and there are no obvious adverse reactions.The method is safe and reliable.