Orban-Schiopu Ana Maria, Popescu Coralia Roxana
Department of Internal Medicine. University Hospital Elias, Bd. Marasti no.17, 71322 Bucharest, Romania.
Rom J Gastroenterol. 2003 Mar;12(1):25-30.
Bleeding from varices is a very serious complication in cirrhotic patients, with a mean mortality rate around 30 %. If the portal vein pressure is decreased by pharmacological therapy the varices will not bleed and progressively decrease in size. The portal hypertension in cirrhotic patients develops as a consequence of two mechanisms: the increase of portal inflow and the increase of intrahepatic resistance. The aim of our study was to find out if propranolol can prevent the bleeding from esophageal varices and if it acts by reducing the portal inflow due to splanchnic vasodilatation. The study was initiated in 53 patients with portal hypertension, of whom 14 were withdrawn because of adverse effects of propranolol. Abdominal ultrasonography and Doppler of portal vein system were performed in all subjects. The ultrasonographic parameters were measured before and after a 3-year treatment with propranolol. The patients also underwent endoscopy for evaluation of esophageal varices; the endoscopy was repeated at the end-point of treatment. We noted that propranolol reduced the portal blood inflow and the size of esophageal varices, and that the incidence of hemorrhages by variceal rupture was very low in these patients.
肝硬化患者的静脉曲张出血是一种非常严重的并发症，平均死亡率约为30%。如果通过药物治疗降低门静脉压力，静脉曲张就不会出血，并且会逐渐缩小。肝硬化患者的门静脉高压是由两种机制导致的：门静脉血流增加和肝内阻力增加。我们研究的目的是确定普萘洛尔是否能预防食管静脉曲张出血，以及它是否通过减少内脏血管扩张引起的门静脉血流来发挥作用。该研究始于53例门静脉高压患者，其中14例因普萘洛尔的不良反应而退出。对所有受试者进行了腹部超声检查和门静脉系统多普勒检查。在使用普萘洛尔进行3年治疗前后测量超声参数。患者还接受了内镜检查以评估食管静脉曲张；在治疗终点重复进行内镜检查。我们注意到普萘洛尔减少了门静脉血流和食管静脉曲张的大小，并且这些患者中静脉曲张破裂出血的发生率非常低。
