本文選題：普萘洛爾 + 食管胃底靜脈曲張出血�。� 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：背景:食管胃底靜脈曲張破裂出血(esophageal and gastric varicesbleeding，EGVB)病情危急，死亡率高達(dá)43.5%，故積極防治靜脈曲張首次出血顯得尤為關(guān)鍵。內(nèi)鏡套扎術(shù)（endoscopic variceal ligation，EVL）和普萘洛爾（propranolol，PPL）是EGVB首次出血預(yù)防一線診療措施。臨床中何者具有更高的臨床療效，至今仍眾說紛紜。 目的：比較PPL和EVL防治EGVB首次出血療效及安全性，為臨床實(shí)踐提供循證醫(yī)學(xué)指導(dǎo)。 方法:在PubMed、萬方數(shù)據(jù)資源系統(tǒng)、MEDLINE、百鏈外文搜索、維普資訊網(wǎng)（VIP）及中國知網(wǎng)(CNKI)系統(tǒng)全面進(jìn)行中文及外文語種文獻(xiàn)搜索。納入所有符合本Meta的隨機(jī)對照試驗(yàn)（randomized controlled trials，，RCTs）；同時(shí)將檢索所有文獻(xiàn)的參考文獻(xiàn)作為參考補(bǔ)充。檢索具體日期從1999年1月到2013年12月。通過瀏覽檢索文獻(xiàn)標(biāo)題、摘要及全文，排除不符合納入標(biāo)準(zhǔn)的隨機(jī)對照試驗(yàn)。本文選擇死亡率、出血率、出血相關(guān)死亡率、藥物不良反發(fā)生率應(yīng)及門脈高壓性胃粘膜病變發(fā)生率作為最終的分析指標(biāo)。對納入文獻(xiàn)研究的隨機(jī)對照實(shí)驗(yàn)提取數(shù)據(jù)后進(jìn)一步質(zhì)量評價(jià)和研究后，運(yùn)用RevMan5.2軟件統(tǒng)計(jì)分析。 結(jié)果：本文總計(jì)10項(xiàng)RCT納入研究，包括1000名患者，其中PPL組495例，，EVL組有505例。本文合并研究結(jié)果顯示：研究發(fā)現(xiàn)二種治療方式在消化道出血相關(guān)死亡率[RR=0.84、95%CI（0.49,1.45）、P=0.53]、死亡率[RR=1.10、95%CI（0.86,1.40）、P=0.45]、首次出血率[RR=0.77、95%CI（0.48,1.25）、P=0.29]、P=0.53]、門脈高壓性胃粘膜病變發(fā)生率[RR=1.17、95%CI（0.66,2.07）、P=0.59]等方面，二組的差別無統(tǒng)計(jì)學(xué)意義。但EVL組不良反應(yīng)發(fā)生率（21.2%）較PPL組不良反應(yīng)發(fā)生率（7.2%）高，兩組間差異有統(tǒng)計(jì)學(xué)意義[RR=2.81、95%CI（1.75,4.52）、P＜0.0001]。 結(jié)論：PPL治療同EVL治療相比，雖然在死亡率、首次出血率、出血相關(guān)死亡率、門脈高壓性胃粘膜病變發(fā)生率等方面沒有優(yōu)勢，但PPL組不良反應(yīng)發(fā)生率較低。
[Abstract]:Background: esophageal and gastric varicesbleeding (EGVB) is critical and the death rate is up to 43.5%. Therefore, it is critical to actively prevent and cure variceal bleeding for the first time. Endoscopic ligation (endoscopic variceal ligation, EVL) and general Lol (propranolol, PPL) are the first-line diagnosis and treatment of the first hemorrhage of EGVB. Measures, which have higher clinical efficacy in clinical practice, are still widely divergent.
Objective: To compare the efficacy and safety of PPL and EVL in the prevention and treatment of EGVB for the first time, so as to provide evidence-based medical guidance for clinical practice.
Methods: PubMed, Wanfang Data Resource System, MEDLINE, 100 chain foreign search, VP information network (VIP) and Chinese knowledge network (CNKI) system for comprehensive Chinese and foreign language literature search. All the randomized controlled trials (randomized controlled trials, RCTs) which conform to this Meta are included; and the reference literature of all documents will be retrieved as a reference. The specific date from January 1999 to December 2013 was retrieved from January 1999 to December 2013. By browsing the titles, abstracts and full text of the literature, a randomized controlled trial was excluded from the inclusion criteria. The mortality rate, bleeding rate, bleeding related mortality, the incidence of adverse drug reaction and the incidence of portal hypertensive gastric mucosal lesions were selected as final analysis. Indicators. After further evaluation and Research on the quality of data extracted from randomized controlled trials involving literature, RevMan5.2 software was used for statistical analysis.
Results: a total of 10 RCT included 1000 patients, including 495 cases in group PPL, and 505 in group EVL. The results of this study showed that the death rate of two treatments in the digestive tract bleeding associated mortality [RR=0.84,95%CI (0.49,1.45), P=0.53], mortality [RR=1.10,95%CI (0.86,1.40), P=0.45], and initial bleeding rate [RR=0.77,95%C) The incidence of I (0.48,1.25), P=0.29], P=0.53], the incidence of gastric mucosal lesions in the portal hypertension, [RR=1.17,95%CI (0.66,2.07), P=0.59], etc., was not statistically significant in the two groups, but the incidence of adverse reactions in the EVL group (21.2%) was higher than that in the PPL group (7.2%), and the difference between the two groups was statistically significant [RR=2.81,95%CI (1.75,4.52).
Conclusion: compared with EVL treatment, PPL treatment has no advantages in mortality, first bleeding rate, bleeding related mortality, and the incidence of portal hypertensive gastric mucosal lesions, but the incidence of adverse reactions in the PPL group is low.

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2

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