Hartigan P M, Gebhard R L, Gregory P B
Gastrointest Endosc. 1997 Jul;46(1):1-7. doi: 10.1016/s0016-5107(97)70201-3.
Male alcoholics hospitalized with actively bleeding esophageal varices were treated with sclerotherapy or sham sclerotherapy and the outcomes during the index hospitalization were compared.
The 87 patients were a subset of 253 patients enrolled in a prospective, randomized, single-blind, multicenter, controlled trial conducted in 12 VA medical centers. The patients (44 sclerotherapy, 43 sham therapy) were actively bleeding from esophageal varices at either randomization endoscopy (49) or follow-up endoscopy (38). Events and resource use during the index hospitalization were recorded.
In 40 (91%) of the sclerotherapy and 26 (60%) of the sham therapy patients, bleeding was stopped during the endoscopy session (p < 0.001). During the hospitalization, 10 (25%) sclerotherapy and 21 (49%) sham therapy patients died (p = 0.04, relative risk 2.17, 95% CI [1.02, 4.61]); 9 sclerotherapy and 22 sham therapy patients rebled (p = 0.005). The median transfusion requirement was higher for sham therapy (8 vs 4 units, p = 0.001), the number of median ICU hours was greater (101 vs 55, p < 0.001), and more patients in this group required shunt surgery (6 vs 0, p = 0.01).
Sclerotherapy, compared to no sclerotherapy, stops hemorrhage from actively bleeding esophageal varices and reduces use of resources. Sclerotherapy significantly increased hospital survival.
对因食管静脉曲张活动性出血而住院的男性酗酒者采用硬化疗法或假硬化疗法进行治疗，并比较了在本次住院期间的治疗结果。
这87例患者是在12家退伍军人医疗中心进行的一项前瞻性、随机、单盲、多中心对照试验中入组的253例患者的一个子集。这些患者（44例接受硬化疗法，43例接受假治疗）在随机分组内镜检查（49例）或随访内镜检查（38例）时因食管静脉曲张而出现活动性出血。记录本次住院期间的事件和资源使用情况。
在接受硬化疗法的40例患者（91%）和接受假治疗的26例患者（60%）中，在内镜检查期间出血停止（p<0.001）。住院期间，10例（25%）接受硬化疗法的患者和21例（49%）接受假治疗的患者死亡（p = 0.04，相对风险2.17，95%CI[1.02, 4.61]）；9例接受硬化疗法的患者和22例接受假治疗的患者再次出血（p = 0.005）。假治疗组的中位输血需求量更高（8单位对4单位，p = 0.001），中位重症监护病房小时数更多（101小时对55小时，p<0.001），该组中更多患者需要分流手术（6例对0例，p = 0.01）。
与不进行硬化疗法相比，硬化疗法可止住食管静脉曲张活动性出血并减少资源使用。硬化疗法显著提高了住院生存率。
