预防水再出血的预防方法
Jaume Bosch1, Juan Carlos García-Pagán
1Hepatic Haemodynamic Laboratory, Liver Unit, Institut de Malalties Digestives, Hospital Clínic, IDIBAPS, University of Barcelona, 08036, Barcelona, Spain. jbosch@medicina.ub.es
Lancet (London, England)
|March 22, 2003
概括
在肝硬化患者中预防水再出血可以通过将异-5-单酸盐 (ISMN) 添加到β阻塞剂中来改善,对于那些 portal 压力降低不足的人来说. 这种向药物治疗可以提高高风险个体的治疗结果.
科学领域:
- 肝病学和胃肠病学 肝病学和胃肠学
- 临床试验和治疗方法
背景情况:
- 腹出血是肝硬化患者门高血压的严重并发症,导致高的复出血率和死亡率.
- 目前的预防策略包括内镜带绑定 (EBL),TIPS和使用β-阻断剂的药物治疗,每个都有局限性.
- 识别那些将受益于特定药物治疗方案的患者对于有效预防复出血至关重要.
研究的目的:
- 评估在患有肝硬化和门性高血压的患者中添加异类-5-单酸盐 (ISMN) 添加到β抑制剂治疗的疗效.
- 确定是否监测肝静脉压力梯度 (HVPG) 可以指导治疗调整以防止水再出血.
- 为了比较优化药物治疗与内镜带绑定 (EBL) 的有效性.
主要方法:
- 随机对照试验比较EBL与药物治疗 (propranolol +/- ISMN) 在出血幸存者.
- 测量肝静脉压梯度 (HVPG),以评估在药物治疗后门压降低的反应.
- 将ISMN添加到β抑制剂中,用于未达到HVPG减少目标的患者.
主要成果:
- 药物治疗显示出与EBL相似的整体再出血率 (44%与1年后的54%相比).
- 将ISMN添加到β-阻断剂中改善了非响应者的HVPG减少,显著降低了再出血率 (10%与64%相比).
- 治疗组之间没有观察到生存率或非出血并发症的显著差异.
结论:
- 长期药物治疗,特别是在HVPG监测和ISMN调整的指导下,是预防水再出血的有效策略.
- 监测HVPG对于识别需要强化药物治疗的患者至关重要.
- 需要进行进一步的试验,以确定当前药物治疗不响应患者的最佳治疗方法.
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