内镜下硬化剂注射联合普萘洛尔治疗食管胃底静脉曲张破裂出血的临床研究(1)
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2010年11月5日
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[摘要] 目的：观察肝硬化食管胃底静脉曲张破裂出血患者，内镜下硬化剂注射联合口服普萘洛尔与单纯内镜下硬化剂注射，治疗止血成功率及再出血发生率。方法：入选有效随访患者115例，其中59例采用硬化剂注射治疗，56例采用硬化剂注射联合口服普萘洛尔治疗，全部患者观察12个月，比较两组间的止血成功率及再出血发生率。结果：硬化剂治疗组及联合治疗组治疗前各级别构成及Child-Pugh评分值组间比较，差异无统计学意义(P>0.05)。硬化剂治疗组及联合治疗组的止血成功率差异无统计学意义(P>0.05)。但再出血发生率，联合治疗组较硬化剂治疗组明显降低(P<0.05)。结论：硬化剂治疗组及联合治疗组均有较高止血成功率，联合治疗组可显著降低再出血发生率。
[关键词] 食管胃底静脉曲张破裂出血；内镜下硬化剂注射；普萘洛尔
[中图分类号] R571.3 [文献标识码]A[文章编号]1674-4721(2010)11(a)-019-02
The clinical study of treatment of esophageal and gastric varices bleeding by endoscopic injection scolerotherapy combined with propranolol
ZHEN Zhongwei, TONG Xuecheng, ZHEN Jian, CHEN Dinggui
(Department of Hepatology, the Third People′s Hospital of Changzhou City, Jiangsu Province, Changzhou 213001, China)
[Abstract] Objective: To observe the cirrhotic patients with bleeding esophageal varices endoscopic sclerotherapy combined with oral propranolol, and simple endoscopic sclerotherapy hemostasis success rate and rebleeding rate. Methods: 115 patients were selected for effective follow-up, 59 were treated with sclerotherapy, and 56 were treated with sclerotherapy combined with oral propranolol therapy, all patients observed for 12 months, compared the success rate of bleeding between the two groups and re-bleeding incidence. Results: The sclerotherapy group and combined treatment group before treatment and at all levels constitutes the value of Child-Pugh score differences between groups was not significant(P>0.05). Sclerotherapy group and combined treatment group success rate of hemostasis was no significant difference(P>0.05). However, rebleeding rate, combined treatment group than in the sclerotherapy group was significantly lower(P<0.05). Conclusion: The sclerotherapy group and combined treatment group has a higher success rate of bleeding, combination therapy significantly reduce rebleeding rate.
[Key words] Esophageal variceal bleeding; Endoscopic sclerotherapy; Propranolol
食管胃底静脉曲张破裂出血是肝硬化患者的危重并发症和主要死亡原因，文献报道[1]首次出血的死亡率高达50%，再次出血的死亡率更高，首次出血后积极止血及预防再出血十分重要。本研究笔者对本院2007年以来收治的115例肝硬化食管胃底静脉曲张破裂出血住院患者进行了临床疗效观察，比较内镜下硬化剂注射治疗联合药物治疗与单纯硬化剂治疗的近期疗效。
1 资料与方法
1.1 一般资料
115例患者均因上消化道出血于2007年4月～2010年2月住本院治疗，临床表现为呕血、便血及黑便，经B超或腹部CT确诊为肝硬化，并经胃镜证实系食管胃底静脉曲张破裂出血。其中，男81例，女34例，年龄34～78岁，平均(52.3±14.4)岁。乙肝后肝硬化78例，丙肝后肝硬化14例，血吸虫性肝硬化5例，酒精性肝硬化15例，原发性胆汁性肝硬化3例。6例患者曾行脾切除加贲门周围血管离断术。肝功能Child-Pugh改良法分级：A级19例，B级71例，C级25例。食管静脉曲张程度内镜分级按照2004年中华消化内镜学会制定的分级标准[2] ......
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