心得安联合艾狄莫尼预防肝硬化门脉高压性再出血的临床研究

周小平等

[摘要] 目的 研究心得安（普萘洛尔）联合艾狄莫尼（单硝酸异山梨酯缓释胶囊）预防肝硬化门脉高压性再出血的疗效。 方法 将78例肝硬化门脉高压性再出血病例随机分成治疗组39例，对照组39例，两组常规治疗相同。对照组给予心得安起始量15mg/d，分3次口服，每2天加量50%，用药后目标为心率较原心率减慢25%但心率≥60次/min。治疗组在对照组的基础上加服艾狄莫尼起始量20mg/d，3d后直接加至40mg/d，1次口服。随访再出血、再出血后死亡情况，如出现出血，则收住院治疗。 结果 治疗组2年后再出血发生率为20.5%、再出血后死亡率为5.1%，对照组2年后再出血发生率为41.0%、再出血后死亡率为23.1%，两组比较差异有统计学意义（P<0.05）；两组不良反应发生率比较，差异无统计学意义（P>0.05）。 结论 心得安联合艾狄莫尼预防肝硬化门脉高压性再出血疗效确切，优于单独使用心得安的疗效，且副作用较小，服用方便，价格便宜，值得推广应用。

[关键词] 心得安；艾狄莫尼；肝硬化；门脉高压；再出血

[中图分类号] R657.3 [文献标识码] B [文章编号] 2095-0616（2015）11-57-03

[Abstract] Objective To investigate effect of propranolol combined with rddie moni （isosorbide mononitrate sustained-release capsules） in preventive portal hypertensive rebleeding. Methods 78 cases with liver cirrhosis portal hypertension rebleeding were randomly divided into a treatment group and a control group， with 39 cases in each， the two groups received the same conventional therapy. The control group were given propranolol initial weight 15mg/d， oral 3 times， dosage of 50%each 2d， target is after medication for heart rate than the original heart rate slowed 25%， but heart rate was greater than 60 beats/min. The treatment group added eddie moni initial amount was 20mg/d on the basis of the control group， after 3ds added directly to 40mg/d， once oral. The follow-up rebleeding， death after rebleeding， were hospitalized. Results The rebleeding rate of treatment group after 2 years was 20.5%， mortality was 5.1%， rebleeding rate in the control group was 41%， mortality was 23.1%， the difference between the two groups was significant （P<0.05）. Conclusion Propranolol combined with eddie moni can significantly reduce the incidence of rebleeding and mortality of liver cirrhosis portal hypertension， the side effect is small， easy to take， the price is cheap， is worthy of popularization and application.

[Key words] Propranolol； Eddie Moni； Liver cirrhosis； Portal hypertension； Rebleeding

肝硬化门脉高压（PHT）性再出血临床治疗较为棘手，为探讨更好的治疗方法，2010年1月～2014年12月笔者用心得安联合艾狄莫尼预防肝硬化PHT性再出血取得一些效果，现报道如下。

1 资料与方法

1.1 一般资料

我院内科2010年1月～2012年12月因肝硬化PHT性出血住院治疗后缓解的病例78例，经多种检查确诊为肝硬化失代偿期并有PHT存在，

Child-Pugh分级为 A级或B级，所选病例均除外COPD、支气管哮喘、低血压、心动过缓、房室传导阻滞、心功能不全、糖尿病及严重肝肾功能损害等情况。年龄37～83岁，平均49岁；……