CAJ | 학술논문

目的比较口服普奈洛尔联合5-单硝酸舁山梨醇酯与内镜套扎对肝硬化食管静脉曲张再出血的预防效果.方法 2000-2005年间,146例肝硬化食管静脉曲张患者分别给予口服普奈洛尔联合5-单硝酸异山梨醇酯与内镜套扎治疗,追踪随访2年,比较两组再出血率、病死率、并发症发生率的情况.结果药物治疗组与内镜套扎组的冉出血率分别为34.3%、36.2%;病死率为12.9%、15.9%,两者差别无统计学意义(P>0.05).并发症发生率分别为7.1%、24.6%,药物治疗组低于内镜套扎(P<0.05).对于肝功能较好者(Child-Pugh分级A和B)药物治疗的再出血率较内镜套扎治疗要低(11.1%/36.2%,P<0.05);而肝功能较差者(Child-Pugh分级C),内镜套扎治疗的冉出血率较药物治疗要低(93.8%/36.4%,P<0.05).结论普奈洛尔联合5-单硝酸异山梨醇酯与内镜套扎相比,再出血率、病死率相当,但并发症发生率较低.对于肝功能Child-Pugh分级A和B的肝硬化患者,药物治疗能更有效的预防食管静脉曲张再出血;而肝功能Child-Pugh分级C的患者,内镜套扎治疗更有效.
목적 비교구복보내락이연합5-단초산여산리순지여내경투찰대간경화식관정맥곡장재출혈적예방효과.방법 2000-2005년간,146례간경화식관정맥곡장환자분별급여구복보내락이연합5-단초산이산리순지여내경투찰치료,추종수방2년,비교량조재출혈솔、병사솔、병발증발생솔적정황.결과 약물치료조여내경투찰조적염출혈솔분별위34.3%、36.2%;병사솔위12.9%、15.9%,량자차별무통계학의의(P>0.05).병발증발생솔분별위7.1%、24.6%,약물치료조저우내경투찰(P<0.05).대우간공능교호자(Child-Pugh분급A화B)약물치료적재출혈솔교내경투찰치료요저(11.1%/36.2%,P<0.05);이간공능교차자(Child-Pugh분급C),내경투찰치료적염출혈솔교약물치료요저(93.8%/36.4%,P<0.05).결론 보내락이연합5-단초산이산리순지여내경투찰상비,재출혈솔、병사솔상당,단병발증발생솔교저.대우간공능Child-Pugh분급A화B적간경화환자,약물치료능경유효적예방식관정맥곡장재출혈;이간공능Child-Pugh분급C적환자,내경투찰치료경유효.
Objective To comparison the efficacy of medical therapy (propranolol plue Isosorbide-5-mononitrate(ISMN)and endoscopic varical ligation(EVL)in preventing of variceal rebleeding. Methods 146 patients were randomized treated with medicament and EVL,and followed up in two years. Compare two groups in rebleeding, complications and mortality. Results In medical therapy group ,34. 3% patients were rebleeding, complications and mortality were 7.1% and 12.9% ; in EVL group were 36.2% ,24.6% and 15.9%. Conclu-sion Compared with EVL,medical therapy reduces complications but has no effection on rebleeding and mar-tality in hepatic cirrhosis patients who had variceal bleeding before. By subgrading analysis, medical therapy could significantly reduce the risk rebleeding for patients with Child-Pugh A and B. But for patients with Child-Pugh C,is reverse.