雷贝拉唑联合盐酸普萘洛尔片预防肝硬化食管胃底静脉曲张再出血的临床研究

摘要

目的：比较单用盐酸普萘洛尔片及盐酸普萘洛尔片联合雷贝拉唑预防食管胃底静脉曲张再出血的临床效果。方法将126例肝硬化食管胃底静脉曲张出血或曾出血的患者按随机数字表法分为联合治疗组和对照组，每组63例。2组患者均给予内科综合治疗，控制出血后对照组给予盐酸普萘洛尔片10 mg·次－1，口服，3次·d－1，1年为1个疗程；联合治疗组在对照组治疗的基础上给予雷贝拉唑肠溶片10 mg·次－1，口服，1次·d－1，1年为1个疗程。2组患者治疗起始后均随访12个月。对2组患者3、6及12个月的再出血率进行比较，并观察其病死率及并发症的发生情况。结果随访3个月，2组患者再出血率比较差异无统计学意义（χ2＝0．568，P ＞0．05）。随访6、9个月，联合治疗组再出血率分别为29．1％、38．2％，对照组再出血率为44．2％、53．7％，联合治疗组6、12个月的再出血率明显低于对照组（χ2＝4．327、4．888，均 P ＜0．05）。2组患者病死率比较差异无统计学意义（χ2＝2．67， P ＞0．05）。结论雷贝拉唑联合盐酸普萘洛尔片预防肝硬化食管胃静脉曲张再出血效果较好，疗效优于盐酸普萘洛尔片单药治疗，提示雷贝拉唑钠预防肝硬化食管胃静脉曲张出血有一定作用。%Objective To compare the clinical efficacies of propranolol hydrochloride tablets and combined propranolol hydrochloride tablets and rabeprazole tablets in the prevention of e-sophageal and gastric variceal rebleeding in patients with cirrhosis.Methods On the basis of comprehensive therapy,126 patients with esophageal and gastric variceal bleeding or a history of bleeding were randomly divided into two groups,with 63 patients in each group.The control group was given oral propranolol hydrochloride tablets (10 mg per time,3 times per day)for 1 year.The combined group was treated with propranolol hydrochloride tablets (10 mg per time,3 times per day)and enteric-coated rabeprazole tablets (10 mg per time,once per day)for 1 year. Patients were followed up for 12 months.The 3-month,6-month and 12 month rebleeding rates were measured and mortality rate and incidence of complications were determined in both groups. Results There were no significant differences in the 3-month rebleeding rate and mortality rate between the two groups (χ2 =0.568,P >0.05).However,the 6-month and 12-month rebleeding rates in combined group (29.1% and 38.2%,respectively)were significantly lower than those in control group (44.2% and 53.7%,respectively)(χ2 =4.327 and 4.888,respectively;P <0.05).Conclusion Combined treatment with propranolol hydrochloride and rabeprazole is superior to treatment with propranolol hydrochloride alone for preventing esophageal and gastric variceal re-bleeding in patients with cirrhosis,suggesting a role of rabeprazole in the prevention of esophageal and gastric variceal rebleeding.