Idéo G, Bellati G, Fesce E, Grimoldi D
Department A of Internal Medicine, St. Anna's Hospital, Como, Italy.
Hepatology. 1988 Jan-Feb;8(1):6-9. doi: 10.1002/hep.1840080103.
Propranolol has been reported to prevent the risk of hemorrhage in patients who survived episodes of variceal rupture. Since the first bleeding episode can be lethal, we did a prospective, randomized trial to see whether beta-blockers could also prevent the first hemorrhage. Seventy-nine consecutive cirrhotics with large esophageal varices by endoscopy and who had never bled were randomly allocated to one of the following treatments: placebo; ranitidine (300 mg per day), or nadolol (40 to 120 mg per day)--which is not cardio-selective, reduces portal hypertension and does not interfere with renal flow. Since no significant differences between ranitidine and placebo treatment were observed, the two groups were combined as the control group and compared with the nadolol group. After a mean follow-up of 24 months, only 1 of the 30 patients in the nadolol group had bled, while 11 of the 49 patients in the control group had bled. The percentages of patients who had not bled 1 and 2 years after the inclusion were 100 and 94.4% for the nadolol group and 81.2 and 70.2% for the control group (p less than 0.02), respectively. There were no differences in the mortality rate. In conclusion, nadolol significantly protects against the first gastrointestinal bleeding episode in cirrhotics.
据报道，普萘洛尔可预防静脉曲张破裂发作存活患者的出血风险。由于首次出血发作可能是致命的，我们进行了一项前瞻性随机试验，以观察β受体阻滞剂是否也能预防首次出血。79例经内镜检查有大食管静脉曲张且从未出血的连续性肝硬化患者被随机分配至以下治疗之一：安慰剂；雷尼替丁（每日300毫克），或纳多洛尔（每日40至120毫克）——纳多洛尔无心脏选择性，可降低门静脉高压且不干扰肾血流量。由于雷尼替丁治疗组与安慰剂治疗组未观察到显著差异，这两组被合并为对照组并与纳多洛尔组进行比较。平均随访24个月后，纳多洛尔组30例患者中仅1例出血，而对照组49例患者中有11例出血。纳入研究后1年和2年未出血患者的百分比，纳多洛尔组分别为100%和94.4%，对照组分别为81.2%和70.2%（p<0.02）。死亡率无差异。总之，纳多洛尔可显著预防肝硬化患者的首次胃肠道出血发作。
