卡維地洛對肝硬化食管胃靜脈曲張再出血的預防作用

謝俊鋒　顧秋平　朱方擎　羅清甜　葉鵬　邱榮鋒

[摘要] 目的 探討卡維地洛對肝硬化食管胃靜脈曲張再出血的預防作用。 方法 將2014年1月～2016年6月肝硬化食管胃靜脈曲張于我院就診且行內鏡下治療的60例患者納入研究并依據隨機數字表法分組。對照組30例患者術后常規口服普奈洛爾，觀察組30例則采用卡維地洛，治療6個月。比較兩組治療前后門靜脈內徑、門靜脈主干血流量（QPV）、脾臟厚度改善情況，比較兩組臨床療效。 結果 治療后，觀察組門靜脈內徑、門靜脈主干血流量（QPV）、脾臟厚度均小于對照組，差異有統計學意義（P<0.05）；觀察組肝功能好轉率、腹水好轉率、食管胃靜脈曲張好轉率、再出血發生率均更低，差異有統計學意義（P<0.05）；觀察組總有效率96.67%（29/30），高于對照組的70.00%（21/30），差異有統計學意義（P<0.05）。 結論 卡維地洛與普奈洛爾均是預防肝硬化食管胃靜脈曲張再出血的有效藥物，但前者效果更為顯著，值得推廣。

[關鍵詞] 卡維地洛；肝硬化；食管胃靜脈曲張出血；門脈高壓

[中圖分類號] R656.2 [文獻標識碼] B [文章編號] 1673-9701（2017）36-0035-03

[Abstract] Objective To investigate the preventive effect of carvedilol on esophageal and gastric variceal rebleeding in patients with liver cirrhosis. Methods 60 patients with esophageal varices in our hospital from January 2014 to June 2016 were treated with endoscopic therapy， and were randomLy divided into two groups according to random data table. In the control group， 30 patients received routine oral administration of F Naylor， and 30 patients in the observation group were treated with carvedilol for 6 months. The portal vein diameter， portal vein blood flow（QPV） and spleen thickness were compared before and after treatment， and the clinical efficacy of the two groups was compared. Results After treatment， the diameter of portal vein， the blood flow volume of portal vein（QPV） and the thickness of spleen in the observation group were all less than those in the control group， the difference was significant（P<0.05）； The improvement rate of liver function， the improvement rate of ascites， the improvement rate of esophageal and gastric varices and the incidence of rebleeding in the observation group were lower than those in the observation group， and the difference was significant（P<0.05）； The total effective rate of the observation group was 96.67%（29/30）， which was higher than 70.00% of the control group （21/30）， the difference was significant（P<0.05）. Conclusion Carvedilol and F Naylor are effective drugs to prevent esophageal and gastric varices rebleeding in cirrhosis， but the former is more effective and worthy of promotion.

[Key words] Carvedilol； Cirrhosis； Esophageal and gastric variceal bleeding； Portal hypertension

我國是慢性肝病高發的國家，包括慢性乙型肝炎、慢性丙型肝炎及酒精性肝病等疾病，總體患病率近20%[1]。慢性肝病若得不到及時治療可發展為肝硬化，可引起諸多并發癥[2]。在門靜脈高壓的作用下，可引起食管胃底靜脈曲張，可因飲食、情緒、血壓升高等因素影響而引起出血，被視為肝硬化失代償期患者嚴重并發癥之一，出血量多時可因失血性休克而危及生命。電子內鏡在消化系統疾病診療中的重要性日漸增強，但預防術后出血仍是臨床亟待研究的重要課題[3]。目前國內外多主張應用一線藥物普奈洛爾預防止血，但存在不良反應大，且療效得到多項研究質疑[4]。卡維地洛是新型降門脈壓力藥物，但目前相關研究報道較少。本研究卡維地洛在食管胃靜脈曲張出血的報道甚少。……