Avgerinos A, Rekoumis G, Klonis C, Papadimitriou N, Gouma P, Pournaras S, Raptis S
2nd Department of Gastroenterology, Evangelismos Hospital, Athens, Greece.
J Hepatol. 1993 Sep;19(2):301-11. doi: 10.1016/s0168-8278(05)80586-0.
The purpose of this study was to investigate the possible value of continuous administration of propranolol in the prevention of recurrent upper gastrointestinal bleeding in patients with cirrhosis undergoing chronic endoscopic sclerotherapy. Among 239 patients admitted for acute variceal bleeding, 85 with cirrhosis were randomized to receive sclerotherapy either alone (40) or in combination with propranolol (45). Sclerotherapy was carried out with an intravariceal injection of 5% ethanolamine oleate through a fiberoptic endoscope. The procedure was performed every week, until the esophageal varices at the gastroesophageal junction were too small for any further injections. Varices were reinjected if they recurred. Propranolol was given orally twice a day until heart rate was reduced by 25% in the resting position. The mean follow-up period was 23.2 and 24.2 months for sclerotherapy and the sclerotherapy plus propranolol groups, respectively. During this period a significant (P = 0.001) reduction in the recurrence of esophageal varices was observed in patients treated with the combination of sclerotherapy plus propranolol compared with those treated with sclerotherapy alone. However, the time of rebleeding from any source or from esophageal varices did not differ significantly between the two groups. In the sclerotherapy group 21 patients rebled (35 bleeding episodes) compared with 14 (22 episodes) in the combination therapy group. Patients in the sclerotherapy group were more prone to bleed from gastric varices and congestive gastropathy than patients treated with the combination of sclerotherapy plus propranolol (P = 0.012). Twenty-five patients in the endoscopic sclerotherapy group developed complications attributed to sclerotherapy compared with 23 patients in the sclerotherapy plus propranolol group. Complications directly attributable to propranolol were observed in 11 patients. Three of these patients stopped taking the drug due to heart failure (1) and flapping tremor (2). Eight patients (17.8%) died in the latter group while the corresponding figure in the sclerotherapy group was nine (22.5%). It is concluded that the continuous administration of propranolol may reduce incidences of recurrent upper gastrointestinal hemorrhage from gastric sources in patients with cirrhosis undergoing chronic sclerotherapy.
本研究的目的是探讨持续给予普萘洛尔在预防接受慢性内镜硬化治疗的肝硬化患者复发性上消化道出血方面的潜在价值。在239例因急性静脉曲张出血入院的患者中，85例肝硬化患者被随机分为单独接受硬化治疗组（40例）或联合普萘洛尔治疗组（45例）。通过纤维内镜进行静脉曲张内注射5%油酸乙醇胺进行硬化治疗。每周进行一次该操作，直到胃食管交界处的食管静脉曲张太小无法进一步注射为止。如果静脉曲张复发则再次注射。普萘洛尔每日口服两次，直到静息心率降低25%。硬化治疗组和硬化治疗加普萘洛尔组的平均随访期分别为23.2个月和24.2个月。在此期间，与单独接受硬化治疗的患者相比，接受硬化治疗加普萘洛尔联合治疗的患者食管静脉曲张复发率显著降低（P = 0.001）。然而，两组间任何来源或食管静脉曲张再出血的时间无显著差异。硬化治疗组有21例患者再次出血（35次出血事件），而联合治疗组为14例（22次事件）。与接受硬化治疗加普萘洛尔联合治疗患者相比，硬化治疗组患者更容易因胃静脉曲张和充血性胃病出血（P = 0.012）。内镜硬化治疗组有25例患者发生了归因于硬化治疗的并发症，而硬化治疗加普萘洛尔组为有23例。在11例患者中观察到直接归因于普萘洛尔的并发症。其中3例患者因心力衰竭（1例）和扑翼样震颤（2例）而停药。后一组中有8例患者（17.8%）死亡，而硬化治疗组相应数字为9例（22.5%）。得出的结论是，持续给予普萘洛尔可能降低接受慢性硬化治疗的肝硬化患者胃源性复发性上消化道出血的发生率。
