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[目的]探讨内镜套扎术治疗后口服卡维地洛预防肝硬化食管静脉曲张破裂出血患者再出血的效果。[方法]选取我院2013年1月~2014年12月收治的肝硬化食管静脉曲张破裂出血患者72例。根据入院诊治时间顺序,将72例患者交替分为对照组及观察组,每组患者36例。2组患者行内镜下套扎术后,对照组患者口服普萘洛尔进行治疗,观察组口服卡维地洛进行治疗。比较2组患者临床疗效及不良反应情况。[结果]观察组患者平均随访时间20.2个月,对照组平均随访时间20.0个月,观察组患者平均每天口服药物剂量为(17.36±5.69)mg,对照组患者平均每天口服药物剂量为(95.36±18.63)mg,观察组患者每天口服药物剂量明显低于对照组(P<0.05);观察组患者总出血率明显低于对照组(2.77%vs.16.66%)(P<0.05);观察组食管静脉曲张改善程度明显优于对照组(P<0.05);在服药依从性比较方面,观察组自行停药率低于对照组(2.77%vs.19.44%),差异有统计学意义(P<0.05);2组患者在治疗过程中以胸痛、发热、头晕、心动过缓为主要不良反应,观察组不良反应总发生率明显低于对照组(19.44%vs.52.77%),差异有统计学意义(P<0.05)。[结论]内镜治疗后口服卡维地洛预防肝硬化食管静脉曲张破裂出血患者再出血临床疗效显著,安全性高,值得临床推广。
[Objective] To investigate the effect of oral carvedilol on preventing rebleeding in patients with cirrhosis esophageal variceal bleeding after endoscopic ligation. [Methods] Seventy-two patients with esophageal variceal bleeding were enrolled in our hospital from January 2013 to December 2014. According to the order of admission and treatment, 72 patients were divided into control group and observation group alternately, with 36 patients in each group. After endoscopic ligation in both groups, patients in the control group were treated with propranolol orally and in the observation group were treated with carvedilol orally. The clinical efficacy and adverse reactions of the two groups were compared. [Results] The average follow-up time was 20.2 months in the observation group and 20.0 months in the control group. The average daily oral dose of the observation group was (17.36 ± 5.69) mg, while that of the control group was (95.36 ± 18.63) mg, the daily oral dose of the observation group was significantly lower than that of the control group (P0.05); the total bleeding rate of the observation group was significantly lower than that of the control group (2.77% vs.16.66%) (P0.05) The improvement rate of varicose veins was significantly better than that of the control group (P <0.05). Compared with the control group (2.77% vs.19.44%), the medication withdrawal rate of the observation group was significantly lower than that of the control group (P <0.05) ). The two groups of patients had chest pain, fever, dizziness and bradycardia as the main adverse reactions in the course of treatment. The total adverse reaction rate in the observation group was significantly lower than that in the control group (19.44% vs.52.77%), with significant difference (P <0.05). [Conclusion] The efficacy of oral carvedilol in the prevention of rebleeding in patients with esophageal variceal bleeding after endoscopic treatment is significant, safe and worthy of clinical promotion.