卡维地洛联合EVL预防肝硬化腹水患者食管静脉曲张再出血的临床研究.docxVIP

卡维地洛联合EVL预防肝硬化腹水患者食管静脉曲张再出血的临床研究 　　【摘要】目的：探讨卡维地洛联合内镜套扎术（evl）预防肝硬化腹水患者食管静脉曲张再出血的临床研究。方法：选取本院2016年1月-2018年2月收治肝硬化腹水食管静脉曲张破裂出血患者76例，依据入院诊治时间的先后顺序将患者分成对照组和观察组，每组38例。对照组行普萘洛尔联合evl治疗，观察组行卡维地洛联合evl治疗。患者术后均随访12个月，比较两组临床疗效、再出血发生率、脾脏硬度及不良反应发生情况。结果：术后随访12个月，观察组临床总有效率为92.11%，高于对照组的73.68%，差异有统计学意义（字2=4.574，p=0.033）;觀察组食管静脉曲张再出血率为10.53%，明显低于对照组的31.58%，差异有统计学意义（p0.05）;治疗12个月后，两组脾脏硬度弹性值均较治疗前明显降低，且观察组低于对照组，差异均有统计学意义（p0.05）;观察组不良反应总发生率为18.42%，低于对照组的42.11%（p0.05）。结论：卡维地洛联合evl可增强肝硬化腹水患者食管静脉曲张再出血的临床疗效，减少再出血发生率，降低脾脏硬度，具有良好的安全性，值得应用推广。 　　【关键词】卡维地洛内镜套扎肝硬化食管静脉曲张 　　[abstract]objective：toinvestigatetheclinicalstudyofcarvedilolcombinedwithendoscopicligation（evl）forthepreventionofesophagealvaricoserebleedinginpatientswithcirrhoticascites.method：atotalof76patientswithruptureandhemorrhageofesophagealvaricoseveinsincirrhosisandascitesadmittedtoourhospitalfromjanuary2016tofebruary2018wereselected.accordingtothetimesequenceofadmission，thepatientsweredividedintocontrolgroupandobservationgroup，38casesineachgroup.patientsinthecontrolgroupreceivedpropranololcombinedwithevl，andpatientsintheobservationgroupreceivedcarvedilolcombinedwithevl.thepatientswerefollowedupfor12months，andtheclinicaleffect，rebleedingrate，spleenhardnessandadversereactionswerecomparedbetweenthetwogroups.result：after12monthsfollow-up，thetotalclinicaleffectiverateoftheobservationgroupwas92.11%，higherthan73.68%ofthecontrolgroup，thedifferencewasstatisticallysignificant（字2=4.574，p=0.033）.therebleedingrateofesophagealvaricesintheobservationgroupwas10.53%，whichwassignificantlylowerthan31.58%inthecontrolgroup，thedifferencewasstatisticallysignificant（p0.05）.after12monthsoftreatment，thehardnessandelasticityofspleeninthetwogroupsweresignificantlylowerthanthoseofbeforetreatment，andtheobservationgroupwaslowerthanthatinthecontrolgroup，thedifferenceswerestatisticallysignificant（p0.05）.thetotalincidenceofadversereactionsintheobservationgroupwas18.42%，lowerthan42.11%inthecontrolgroup（p0.05）.conclusion：carvedilolcombinedwithevlcanenhanceth