本文選題：卡維地洛　切入點(diǎn)：食管靜脈曲張　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:肝硬化食管靜脈曲張破裂出血的患者內(nèi)鏡下治療基礎(chǔ)上,分別聯(lián)合卡維地洛以及不聯(lián)合非選擇性β受體阻滯劑,比較其再出血率、生存率、肝靜脈壓力梯度(HVPG)的變化,從而研究卡維地洛在肝硬化食管靜脈曲張出血的二級(jí)預(yù)防中的臨床意義,為臨床上治療肝硬化食管靜脈曲張出血提供科學(xué)參考依據(jù)。研究方法:回顧性分析從2010年1月至2016年1月于山東大學(xué)附屬省立醫(yī)院(東院區(qū))住院的375例肝硬化食管靜脈曲張破裂出血的患者,共篩選出符合條件的研究對(duì)象93人,其中隨訪資料齊全的82人。其中內(nèi)鏡聯(lián)合卡維地洛治療組50例(隨訪資料齊全42例),單純內(nèi)鏡治療組43例(隨訪資料齊全40例),兩組的主要研究終點(diǎn)均為再出血時(shí)間,次要終點(diǎn)為死亡時(shí)間。統(tǒng)計(jì)兩組的信息,并經(jīng)過(guò)隨訪,收集患者接受治療后至2017年3月15日的基本狀況,包括:再出血時(shí)間,藥物不良反應(yīng),追加治療,死亡時(shí)間和原因等,并比較內(nèi)鏡聯(lián)合卡維地洛治療組經(jīng)藥物治療后肝靜脈壓力梯度(HVPG)的變化。統(tǒng)計(jì)兩組的再出血率和生存率,以及內(nèi)鏡聯(lián)合卡維地洛治療組患者出現(xiàn)的藥物不良反應(yīng)和不耐受患者的比例。應(yīng)用統(tǒng)計(jì)軟件SPSS19.0進(jìn)行相關(guān)數(shù)據(jù)的分析。結(jié)果內(nèi)鏡聯(lián)合卡維地洛治療組患者治療前的HVPG為14.26±5.88mmHg,經(jīng)治療后下降至12.92±6.76mmHg,差異有統(tǒng)計(jì)學(xué)意義(t=2.504,P=0.019)。兩組患者隨訪時(shí)間分別為(36.85±20.04)個(gè)和(29.32± 15.82)個(gè)月,隨訪期間出現(xiàn)再出血的人數(shù)為43人,其中內(nèi)鏡聯(lián)合卡維地洛治療組20人,單純內(nèi)鏡治療組23人。內(nèi)鏡聯(lián)合卡維地洛治療組和單純內(nèi)鏡治療組三年內(nèi)總再出血率為42.86%和57.5%,差異有統(tǒng)計(jì)學(xué)意義。內(nèi)鏡聯(lián)合卡維地洛治療組和單純內(nèi)鏡治療組治療后1年、2年、3年累計(jì)未再出血率分別為(73.2%,58.3%,50.7%)vs(70.0%,48.7%,39.0%),內(nèi)鏡聯(lián)合卡維地洛治療組高于單純內(nèi)鏡治療組,有統(tǒng)計(jì)學(xué)意義(Log rank檢驗(yàn),卡方=4.039,P=0.044)。兩組3年內(nèi)死亡人數(shù)分別為1人和5人,死亡率分別為2.38%和12.5%,內(nèi)鏡聯(lián)合卡維地洛治療組低于單純內(nèi)鏡治療組,但無(wú)明顯統(tǒng)計(jì)學(xué)上的差異(P=0.09)。內(nèi)鏡聯(lián)合卡維地洛治療組患者用藥后,有出現(xiàn)體位性低血壓(7.14%),心動(dòng)過(guò)緩(4.76%),頭暈(7.14%),因藥物不良反應(yīng)減少用藥量的患者占2.38%,嚴(yán)重者因不耐受而換藥或者停藥(4.76%),但和未使用藥物的患者相比,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),未見(jiàn)顯著差異(P0.05)。結(jié)論:1.卡維地洛可明顯降低食管靜脈曲張出血患者的肝靜脈壓力梯度,從而降低再出血的風(fēng)險(xiǎn);2.卡維地洛可明顯降低食管靜脈曲張出血患者的再出血率,延長(zhǎng)患者未再出血時(shí)間。
[Abstract]:Objective: to compare the rebleeding rate and survival rate with carvedilol and non-selective 尾 receptor blockers on the basis of endoscopic treatment in patients with esophageal variceal hemorrhage due to cirrhosis. To study the clinical significance of carvedilol in the secondary prevention of esophageal variceal hemorrhage due to cirrhosis. Methods: from January 2010 to January 2016, 375 patients with cirrhosis of the liver were hospitalized in Shandong University Provincial Hospital (Eastern Hospital) from January 2010 to January 2016. Patients with esophageal variceal bleeding, A total of 93 eligible subjects were selected. Among them, 82 cases were followed-up, 50 cases were treated by endoscopy combined with carvedilol (42 cases were followed-up, 43 cases were treated with endoscopy alone), 40 cases were followed-up, the main endpoints of both groups were rebleeding time. The secondary endpoints were the time of death. The information of the two groups was counted and followed up. The basic condition of the patients was collected after receiving treatment until March 15, 2017, including: time of rebleeding, adverse drug reactions, supplementary treatment, time of death and cause of death, etc. The changes of hepatic vein pressure gradient (HVPGs) in the endoscopic and carvedilol treated group were compared. The rebleeding rate and survival rate of the two groups were analyzed. And the proportion of adverse drug reactions and intolerance in the endoscopic combined carvedilol group. Statistical software SPSS19.0 was used to analyze the related data. Results the patients in the endoscopic combined carvedilol group before treatment. The HVPG was 14.26 鹵5.88 mm Hg, decreased to 12.92 鹵6.76 mmHg after treatment, the difference was statistically significant (2.504 鹵0.019). The follow-up time of the two groups was 36.85 鹵20.04 and 29.32 鹵15.82 months, respectively. The number of patients with rebleeding during follow-up was 43, including 20 in the endoscopic combined carvedilol group. The total rate of rebleeding in the endoscopic combined with carvedilol group and the simple endoscopic treatment group was 42.86% and 57.5% in three years, the difference was statistically significant. The endoscopic combined carvedilol treatment group and the simple endoscopic treatment group were treated with the total bleeding rate of 42.86% and 57.5% respectively. The accumulative rate of no further bleeding was 73.2% and 58.3%, respectively, one year, two years and three years after the treatment. The accumulative rate of no bleeding was 50.7 / 58.3 and 50.7 / 48.7 / 70.00.The endoscopic combined carvedilol treatment group was higher than the simple endoscopic treatment group. There were significant differences between the two groups in terms of the number of deaths within 3 years (1 person and 5 cases), the mortality rates were 2.38% and 12.5%, respectively. The rate of death in the treatment group of endoscopy combined with carvedilol was lower than that in the group treated with endoscopy alone. However, there was no significant statistical difference between the two groups. There were cases of postural hypotension of 7.14m, bradycardia of 4.76a, dizziness of 7.14m, reduction of drug dosage due to adverse drug reactions (2.38%), and severe patients changing or stopping medicine 4.76g because of intolerance. However, compared with patients who did not use drugs, they underwent statistical tests. Conclusion: 1. Carvedilol can significantly reduce the pressure gradient of hepatic vein in patients with esophageal variceal bleeding, and thus reduce the risk of rebleeding 2.Carvedilol can significantly reduce the rate of rebleeding in patients with esophageal variceal hemorrhage. The time of no further bleeding was prolonged.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575.2

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