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目的 探讨小剂量心得安与川芎嗪联用预防肝硬变食管静脉曲张破裂出血(EVB)复发的疗效、副反应及其作用机制。 方法 在用药前后采用血管插管法对8只肝硬变犬血流动力学指标进行检测。在临床上对治疗组(n=38,po心得安10mg+川芎嗪50mg,3次/d)和安慰剂组(n=36,服维生素B_110mg+维生素PP 50mg,3次/d)进行前瞻性对照研究,随访2a,并用彩色多普勒超声仪监测其门脉系统血流动力学变化。 结果 小剂量心得安与川芎嗪联用可使肝硬变犬WHVP,HVPG,Rpv及Ppv明显降低,对HR,MAP无明显影响。用药4wk后治疗组患者Qpv,Qsv,Dpv,Dsv及Qaz均显著下降(分别为1439±494 vs 1152±387,948±436 vs 529±362,1.43±0.25 vs 1.36±0.28,1.20±0.24 vs 0.85±0.16,0.94±1.18vs 0.71±1.04,P<0.05/0.01);随访2a,安慰剂组再出血率和死亡率均显著高于治疗组(P<0.05);临床上未见明显副作用。 结论 小剂量心得安与川芎嗪联用预防EVB复发是安全有效的。
Objective To investigate the curative effect, side effects and mechanism of low dose of propranolol and ligustrazine in preventing recurrence of cirrhosis esophageal variceal bleeding (EVB). Methods Before and after treatment, the blood flow intubation method was used to detect the hemodynamic indexes of 8 cirrhotic dogs. A prospective controlled study was conducted clinically in the treatment group (n = 38, po propranolol 10mg + ligustrazine 50mg, 3 times / d) and placebo (n = 36, vitamin B_110mg + vitamin PP 50mg, 3 times / d) , Follow-up 2a, and monitor their portal system hemodynamic changes with color Doppler ultrasound. Results Small dose of propranolol and tetramethylpyrazine can significantly reduce the WHVP, HVPG, Rpv and Ppv in dogs with cirrhosis, but had no significant effect on HR and MAP. Qpv, Qsv, Dpv, Dsv and Qaz were significantly decreased in the treatment group after 4 weeks of treatment (1439 ± 494 vs 1152 ± 387, 948 ± 436 vs 529 ± 362, 1.43 ± 0.25 vs 1.36 ± 0.28, 1.20 ± 0.24 vs 0.85 ± 0.16, respectively , 0.94 ± 1.18vs 0.71 ± 1.04, P <0.05 / 0.01). The recurrence rate and mortality of placebo group were significantly higher than those of the treatment group (P <0.05) at follow-up2. No obvious side effects were found in the study. Conclusion Small dose of propranolol and ligustrazine prevent EVB recurrence is safe and effective.