氯沙坦预防肝硬化上消化道出血疗效观察.docVIP

氯沙坦预防肝硬化上消化道出血疗效观察 　【摘要】 目的：寻找控制门静脉高压发生和发展的方法，降低肝硬化门静脉高压的上消化道出血的发生率。方法：对照组肝硬化20例，在常规药物治疗下采用普奈洛尔治疗；观察组肝硬化22例，在常规药物治疗下加用氯沙坦。结果：经2年的观察，与对照组相比观察组发生上消化道出血及死亡例数减少，但差异无显著性（Pgt;0.05）。多元Cox分析显示年龄肝功能与治疗方法仍是影响再出血的指数；氯沙坦可能优于普奈洛尔预防再出血（ρlt;0.05）。另外，观察组出现低血压的副作用增多。结论：氯沙坦预防肝硬化门脉高压致上消化道出血的效果优于或与普奈洛尔相当。 【关键词】 肝硬化；门脉高压； 疗效 　　Observing the Preventive effect of Losartan on Upper Gastrointestinal Bleeding Caused by hepatic cirrhosis 　　　Abstract：Objective: To search for a method which could control the occurrence and development of portal hypertension and could cut down the incidence rate of upper gastrointestinal bleeding caused by portal hypertension. Method: The control group had twenty cases which in treated with routine drug and propranolol, twenty-two cases were observation group which were treated with routione drug and losartan. Result: The result suggested that the number of occurring upper gastrointestinal bleeding in observation group was less than that of control group, but there were no significant statistical differences between two groups(Pgt;0.05). Multielement Cox analysis displayed that age, liver function and therapy means still were the index number of influencing rebleeding.The curative effect of losartan may surpass the curative effect of propranolol(Plt;0.05). In addition, The side effect of hypotensive in observeing group increased. Conclusion: The effect of losartan prevent upper gastrointestinal bleeding caused by hepatic cirrhosis surpass, the curative effect of propranolol or the curative effect of losartan and propranolol were equivalent. 　　Key words: Hepatic cirrhosis； Portal hypertension； Curative effect 　　肝硬化门脉高压所致的上消化道出血发生率很高，是肝硬化患者的主要死亡原因，合并出血的肝硬化患者6周内的病死率高达42%，并有66%的患者在1年内死亡，因此预防肝硬化的初次出血具有重要的临床价值。非选择性β2受体阻滞剂普萘洛尔再出血率下降约40%，但是约20%的患者对普萘洛尔无反应。单用普萘洛尔仍有约50%的患者发生出血，而且约40%患者出现乏力或哮喘等并发症。近来发现，肾素-血管紧张素-醛固酮系统（RAAS）与门静高压关系密切。有研究表明，血管紧张素转换酶受体拮抗剂（ARB）可以安全有效地治疗门静脉高压症［1］。本研究的目的为观察氯沙坦对控制门静脉高压发生和发展的疗效，为降低肝硬化门静脉高压的上消化道出血的发生率提供有效的方法。 　　1 资料与方法 　　1.1 一般资料： 　　选择2001年1月至2004年