内镜下套扎术联合生长抑素治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.01.028

实用肝脏病杂志 ›› 2025, Vol. 28 ›› Issue (1): 108-111.doi: 10.3969/j.issn.1672-5069.2025.01.028

内镜下套扎术联合生长抑素治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*

卓宇宏, 陈平湖, 陈鸿程, 周思君, 陈小云, 范微微, 叶石才

524000 广东省湛江市广东医科大学附属湛江中心医院消化内科(卓宇宏, 陈平湖, 陈鸿程, 周思君, 陈小云);感染病科(范微微);广东医科大学附属医院消化内科(叶石才)

收稿日期:2024-08-19 出版日期:2025-01-10 发布日期:2025-02-07
通讯作者: 叶石才,E-mail:caizi123@126.com
作者简介:卓宇宏,男,38岁,大学本科,副主任医师。E-mail:zyh137630@163.com
基金资助:
^*广东省湛江市科技计划研究项目(编号:2021B01255)

Oral maintaining treatment of propranolol after endoscopic variceal ligation and somatostatin combination for emergent hemostasis in patients with esophagogastric variceal bleeding

Zhuo Yuhong, Chen Pinghu, Chen Hongcheng, et al

Department of Gastroenterology, Central Hospital Affiliated to Guangdong Medical University, Zhanjiang 524000, Guangdong Province, China

Received:2024-08-19 Online:2025-01-10 Published:2025-02-07

摘要/Abstract

摘要： 目的探讨内镜下套扎术(EVL)联合生长抑素和普萘洛尔治疗肝硬化并发食管胃底静脉曲张破裂出血(EVB)患者的疗效。方法 2021年1月～2023年12月我院收治的肝硬化并发EVB患者116例,被随机分为对照组57例和观察组59例,两组均接受EVL和生长抑素治疗,连续治疗3～7 d,观察组术后长期口服普萘洛尔维持治疗,随访6个月。使用超声诊断仪检测门静脉血流量(PVF)和脾静脉血流量(SVF),经颈静脉入路插管测量肝静脉楔压和肝静脉游离压,计算肝静脉压力梯度(HVPG)。常规检测血浆凝血酶原时间(PT)和纤维蛋白原(FIB)。结果在治疗7 d后,观察组止血率为94.9%,对照组为96.5%(P>0.05),观察组死亡3例,对照组死亡2例;两组出血停止时间【(63.5±2.1)对(62.3±3.6)h】、输血量【(3.9±0.8)U对(4.1±1.2)U】、住院时间【(10.4±1.7)d对(10.5±2.9)d】和医疗花费【(1.8±0.2)万元对(1.8±0.2)万元】无显著性差异(P>0.05);治疗后,观察组PVF、SVF和HVPG分别为(541.5±108.6)ml/min、(289.7±53.4)ml/min和(13.5±3.1)mmHg,均显著低于对照组【分别为(616.4±112.7)ml/min、(306.4±56.3)ml/min和(14.6±3.8)mmHg,P＜0.05】;观察组PT为(14.1±1.1)s,FIB为(2.7±0.8)g/L,与对照组【分别为(14.0±1.2)s和(2.8±0.6)g/L】比,无显著性差异(P＜0.05);观察组随访3个月和6个月再出血发生率分别为5.4%和10.7%,与对照组的7.3%和14.6%比,无显著性差异(P>0.05)。结论在EVL联合生长抑素紧急止血后,给予普萘洛尔口服治疗维持能降低门脉压力,可能能降低肝硬化并发门脉高压症患者再出血发生率,值得进一步观察。

关键词: 肝硬化, 食管胃底静脉曲张破裂出血, 内镜下套扎术, 生长抑素, 普萘洛尔, 治疗, 再出血

Abstract: Objective The aim of this study was to investigate oral maintaining treatment of propranolol after endoscopic variceal ligation (EVL) and somatostatin combination for emergent hemostasis in patients with esophagogastric variceal bleeding (EVB). Methods 116 cirrhotics with EVB were admitted to our hospital between January 2021 and December 2023, and were randomly divided into control (n=57) and observation (n=59) groups. All patients in the two groups underwent EVL and intravenous administration of octreotide for emergent hemostasis, and those in the observation received oral propranolol for maintaining treatment after operation. Portal vein flow (PVF) and splenic vein flow (SVF) were detected by ultrasonography, and hepatic venous pressure gradient (HVPG) was calculated after transjugular vein intubation. Plasma prothrombin time (PT) and fibrinogen (FIB) levels were routinely obtained. Results One week after treatment, the hemostasis rate in observation and control group were 94.9% and 96.5% (P>0.05), and three patients died in the observation and 2 died in the control; there were no significant differences as respect to bleeding cessation times [(63.5±2.1)vs. (62.3±3.6)h], blood transfusion [(3.9±0.8)U vs. (4.1±1.2)U], hospital stay [(10.4±1.7)d vs. (10.5±2.9)d] and medical costs [(10.8±2.0)thousand yuan vs. (10.8±2.0)thousand yuan] between the two groups (P>0.05); after treatment, PVF, SVF and HVPG in the observation were (541.5±108.6)ml/min, (289.7±53.4)ml/min and (13.5±3.1)mmHg, all significantly lower than [(616.4±112.7)ml/min, (306.4±56.3) ml/min and (14.6±3.8)mmHg, respectively, P＜0.05] in the control; plasma PT was (14.1±1.1)s and FIB levels was (2.7±0.8)g/L, both not much different as compared to [(14.0±1.2)s and (2.8±0.6)g/L] in the control (P＜0.05); the 3-month and 6-month re-bleeding rates in the observation group were 5.4% and 10.7%, both not significantly different compared to 7.3% and 14.6% in the control group (P>0.05). Conclusion Oral maintaining treatment of propranolol after emergent hemostasis in patients with EVB could reduce portal hypertension, which might reduce re-bleeding and needs long-term investigation.

Key words: Liver cirrhosis, Esophagogastric variceal bleeding, Endoscopic variceal ligation, Somatostatin, Propranolol, Therapy, Re-bleeding

卓宇宏, 陈平湖, 陈鸿程, 周思君, 陈小云, 范微微, 叶石才. 内镜下套扎术联合生长抑素治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(1): 108-111.

Zhuo Yuhong, Chen Pinghu, Chen Hongcheng, et al. Oral maintaining treatment of propranolol after endoscopic variceal ligation and somatostatin combination for emergent hemostasis in patients with esophagogastric variceal bleeding[J]. Journal of Practical Hepatology, 2025, 28(1): 108-111.

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内镜下套扎术联合生长抑素治疗肝硬化并发食管胃底静脉曲张破裂出血患者疗效研究^*

Oral maintaining treatment of propranolol after endoscopic variceal ligation and somatostatin combination for emergent hemostasis in patients with esophagogastric variceal bleeding

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