Silvain C, Chauvin C, Verneau A, Carretier M, Beauchant M
Gastroenterol Clin Biol. 1985 Oct;9(10):670-3.
The aim of the present study was to evaluate how many cirrhotics may receive propranolol after upper gastrointestinal bleeding. One hundred and twelve patients were consecutively admitted in a digestive intensive care unit during a two-year study, for bleeding of esophageal (63 p. 100) or gastric (4 p. 100) varices, or acute gastric erosions (33 p. 100). Twenty-one per cent of patients were initially class A (Child's classification). 26 p. 100 were B, and 53 p. 100 were C. Eighteen patients (16 p. 100) died within the first 10 days. Eighty patients (71 p. 100) did not receive propranolol because of: a) contraindication for this drug (asthma, heart failure, diabetes, n = 25); b) carcinoma, mainly of the liver (n = 11); c) foreseeable lack of compliance with the treatment (n = 8); d) criteria for which the efficacy of propranolol has not been demonstrated (small esophageal varices, jaundice, or ascites, n = 36). Only 14 patients (13 p. 100) received propranolol therapy: 5 stopped their treatment, 3 because of gastrointestinal rebleeding. Our experience suggests that propranolol can be used only in a few cirrhotics for prevention of recurrent gastrointestinal bleeding.
本研究的目的是评估在上消化道出血后有多少肝硬化患者可以接受普萘洛尔治疗。在一项为期两年的研究中，112例患者因食管静脉曲张（63%）、胃静脉曲张（4%）或急性胃黏膜糜烂（33%）连续入住消化重症监护病房。21%的患者最初为A级（Child分级），26%为B级，53%为C级。18例患者（16%）在最初10天内死亡。80例患者（71%）未接受普萘洛尔治疗，原因如下：a）该药物的禁忌症（哮喘、心力衰竭、糖尿病，n = 25）；b）主要为肝癌（n = 11）；c）可预见的治疗依从性差（n = 8）；d）普萘洛尔疗效未得到证实的标准（小食管静脉曲张、黄疸或腹水，n = 36）。只有14例患者（13%）接受了普萘洛尔治疗：5例停止治疗，3例是因为胃肠道再次出血。我们的经验表明，普萘洛尔仅可用于少数肝硬化患者以预防胃肠道出血复发。
