Villanueva C, Martínez F J, Torras X, Sáinz S, Soriano G, González D, Balanzó J
Unidad de Sangrantes, Hospital de la Santa Creu i Sant Pau, Barcelona.
Rev Esp Enferm Dig. 1994 Jul;86(1):499-504.
to assess whether nadolol could improve the results of sclerotherapy in the prevention of varices rebleeding.
prospective study in which patients with cirrhosis and Child-Pugh's class A or B and with their first hemorrhage from esophageal varices, diagnosed by emergency endoscopy, were included. After initial control of bleeding with emergency sclerotherapy, the patients were randomized into two groups to receive long-term variceal sclerotherapy either alone (group 1) or plus nadolol (group 2). Sclerotherapy was performed by intravariceal injection of 5% ethanolamine at days 0, 4 10, 30 and then monthly until eradication of varices. Nadolol was administered during the whole follow-up in a dose to reduce resting pulse rate by 25% (mean final dose: 82 +/- 31 mg/d).
During a two year period (1989-1991), 40 patients with cirrhosis (from alcohol abuse in 48%), were included. 18 patients were allocated in group 1 and 22 in group 2.
Both groups were well-matched for clinical, biological and endoscopic data. Follow-up was similar in both (24.3 +/- 10.6 months in group 1 vs 27.3 +/- 9.8 in group 2). Nine patients in group 1 (50%) and 13 in group 2 (59%) rebled during the follow-up, with a total number of 14 and 22 rebleeding episodes respectively (p = NS). There were no differences between the two groups when considering rebleeding index, transfusional requirements per rebleeding episode and the cumulative percentage of patients free from rebleeding. Severe complications attributable to treatment were observed in 22% of patients in group 1 and in 27% in group 2 (p = NS). Two patients died in each group.
In patients undergoing long-term sclerotherapy for prevention of variceal rebleeding, nadolol confers no additional benefit.
评估纳多洛尔能否改善硬化疗法预防静脉曲张再出血的效果。
一项前瞻性研究，纳入因酒精滥用导致肝硬化（48%）、Child-Pugh分级为A或B级且首次发生食管静脉曲张出血并经急诊内镜确诊的患者。在通过急诊硬化疗法初步控制出血后，将患者随机分为两组，一组单独接受长期静脉曲张硬化疗法（第1组），另一组在接受硬化疗法的基础上加用纳多洛尔（第2组）。硬化疗法通过在第0、4、10、30天经静脉内注射5%乙醇胺进行，之后每月注射一次，直至静脉曲张消除。在整个随访期间给予纳多洛尔，剂量以将静息心率降低25%为准（平均最终剂量：82±31毫克/天）。
在两年期间（1989 - 1991年），纳入40例肝硬化患者（48%因酒精滥用所致）。第1组分配18例患者，第2组分配22例患者。
两组在临床、生物学和内镜检查数据方面匹配良好。两组的随访时间相似（第1组为24.3±10.6个月，第2组为27.3±9.8个月）。随访期间，第1组9例患者（50%）再出血，第2组13例患者（59%）再出血，再出血次数分别为14次和22次（p = 无统计学意义）。在考虑再出血指数、每次再出血发作的输血需求以及无再出血患者的累积百分比时，两组之间无差异。第1组22%的患者和第2组27%的患者出现了与治疗相关的严重并发症（p = 无统计学意义）。每组各有2例患者死亡。
在接受长期硬化疗法预防静脉曲张再出血的患者中，纳多洛尔未带来额外益处。
