谢俊锋　顾秋平　朱方擎　罗清甜　叶鹏　邱荣锋

[摘要] 目的 探讨卡维地洛对肝硬化食管胃静脉曲张再出血的预防作用。 方法 将2014年1月～2016年6月肝硬化食管胃静脉曲张于我院就诊且行内镜下治疗的60例患者纳入研究并依据随机数字表法分组。对照组30例患者术后常规口服普奈洛尔，观察组30例则采用卡维地洛，治疗6个月。比较两组治疗前后门静脉内径、门静脉主干血流量（QPV）、脾脏厚度改善情况，比较两组临床疗效。 结果 治疗后，观察组门静脉内径、门静脉主干血流量（QPV）、脾脏厚度均小于对照组，差异有统计学意义（P<0.05）；观察组肝功能好转率、腹水好转率、食管胃静脉曲张好转率、再出血发生率均更低，差异有统计学意义（P<0.05）；观察组总有效率96.67%（29/30），高于对照组的70.00%（21/30），差异有统计学意义（P<0.05）。 结论 卡维地洛与普奈洛尔均是预防肝硬化食管胃静脉曲张再出血的有效药物，但前者效果更为显著，值得推广。

[关键词] 卡维地洛；肝硬化；食管胃静脉曲张出血；门脉高压

[中图分类号] R656.2 [文献标识码] B [文章编号] 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

我國是慢性肝病高发的国家，包括慢性乙型肝炎、慢性丙型肝炎及酒精性肝病等疾病，总体患病率近20%[1]。慢性肝病若得不到及时治疗可发展为肝硬化，可引起诸多并发症[2]。在门静脉高压的作用下，可引起食管胃底静脉曲张，可因饮食、情绪、血压升高等因素影响而引起出血，被视为肝硬化失代偿期患者严重并发症之一，出血量多时可因失血性休克而危及生命。电子内镜在消化系统疾病诊疗中的重要性日渐增强，但预防术后出血仍是临床亟待研究的重要课题[3]。目前国内外多主张应用一线药物普奈洛尔预防止血，但存在不良反应大，且疗效得到多项研究质疑[4]。卡维地洛是新型降门脉压力药物，但目前相关研究报道较少。本研究卡维地洛在食管胃静脉曲张出血的报道甚少。……