预防肝硬化上消化道出血的临床研究

PROPHYLACTIC MANAGEMENT OF GASTROINTESTINAL HEMORRHAGE IN PATIENTS WITH HEPATOCIRRHOSIS

目的 探讨普萘洛尔和低剂量兰索拉唑长期维持治疗对预防肝硬化门脉高压消化道出血的疗效。方法 1 1 9例肝硬化门脉高压患者随机分为 3组 :Ⅰ组 :给予口服普萘洛尔加上护肝治疗。Ⅱ组 :联合给予低剂量兰索拉唑和普萘洛尔。Ⅲ组 :仅给予护肝治疗。兰索拉唑维持服药 6个月 ,普萘洛尔及一般对症治疗维持 1年。观察治疗前后各组患者所伴发溃疡、门脉高压性胃病 (PHG)、急性胃黏膜病变 (AGML)情况 (发生率 ) ,各组消化道出血的复发率、门静脉直径 (PVD)、脾静脉直径 (SVD)的变化。结果 经 1年观察 ,结果显示 ,普萘洛尔组、联合治疗组、对照组出血的复发率分别为 1 5 0 %、2 2 %、48 5 % ,组Ⅰ、组Ⅱ复发率显著低于组Ⅲ ,同时 ,组Ⅰ与组Ⅱ间的差异有显著性意义。治疗可见组Ⅰ、组Ⅱ患者所伴发的溃疡、PHG、AGML明显改善 ,PVD、SVD缩小。结论 普萘洛尔组联合抑制酸维持治疗 ,可预防引起消化道出血多种病因 。

Objective\ To study the efficacy of propranolol combined with long-term maintenance therapy with low-dose lansoprazole in prevention of the bleeding of patients with hepatocirrhosis.Methods\ 119 patients with hepatocirrhosis portal hypertension were enrolled and randomly divided into three groups:group Ⅰ(propranolol),group Ⅱ (propranolol plus low-dose lansoprazole),group Ⅲ (only general treatment).The duration of maintenance therapy with lansoprazole was six months,that of propranolol and general treatment was 12 months,respectively.The recurrence rates of hemorrhage,ulceration,PHG,AGML along with the SVD,PVD were observed before and after the period of observation.Results\ After one year′s observation,the annual recurrence rates of hemorrhage were 15.0%,2.2% and 48.5% in group Ⅰ,group Ⅱ,group Ⅲ,respectively.There was significant difference before and after the treatment in group Ⅰ and group Ⅱ.The lesion of ulceration,PHG,AGML had improved.The recurrence rates of hemorrhage in group Ⅱ was significantly lower than that of group Ⅰ.Conclusion\ The prevention of hemorrhage in patients with hepatocirrhosis and portal hypertension is effective by lansoprazole plus propranolol.