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目的观察活血软坚、化瘀通络法治疗肝脾血瘀型肝硬化并发上消化道出血患者的临床疗效及治疗前后患者血流动力学的变化。方法选取我院消化内科2012年1月~2015年1月收住入院的肝硬化并发上消化道出血患者76例,随机分为试验组38例和对照组38例。给予对照组垂体后叶素和奥曲肽静脉滴注,试验组在对照组基础上给予中药“隔下逐瘀汤”加减治疗,治疗14 d。使用Olympus 240/260电子胃镜检查,使用西门子X150彩色多普勒超声显像仪测定门静脉和脾静脉内径(D)和血流流速(V)。观察中医症状积分变化。结果试验组平均止血时间为(35.82±12.47)h,对照组平均止血时间为(49.16±11.58)h,经统计学分析,t=10.254,P=0.000<0.05,差异有统计学意义;治疗后,试验组中医证候积分为(10.25±7.54),对照组中医证候积分为(13.47±6.73),两组经统计学分析,t=4.538,P=0.000<0.005,差异有统计学意义;试验组门静脉血流量为(580.34±176.38)ml/min,对照组为(650.25±142.47)ml/min,差异有统计学意义(P<0.05);试验组脾静脉血流量为(213.36±90.74)ml/min,对照组为(286.74±101.25)ml/min,差异有统计学意义(P<0.05);治疗后试验组门静脉内径、脾静脉内径改善方面明显优于对照组,差异有统计学意义(P<0.05)。结论活血软坚、化瘀通络法联合止血药治疗肝硬化上消化道出血患者临床疗效满意,对患者脾静脉和门静脉血流动力学改善明显,治疗方法简便可行,患者依从性高。
Objective To observe the clinical efficacy of Huoxue Ruanjian and Huayu Tongluo in treating patients with liver cirrhosis complicated with upper digestive tract hemorrhage and the changes of hemodynamics before and after treatment. Methods A total of 76 patients with cirrhosis and upper gastrointestinal bleeding admitted to our hospital from January 2012 to January 2015 were randomly divided into experimental group (38 cases) and control group (38 cases). Give the control group pituitrin and octreotide intravenous infusion, the experimental group on the basis of the control group to give Chinese medicine “separated next Zhuyu Decoction” "plus treatment, for 14 days. The diameter of the portal and splenic vein (D) and blood flow velocity (V) were measured using an Olympus 240/260 electron gastroscope using a Siemens X150 color Doppler ultrasound imaging machine. Observation of TCM symptom score changes. Results The average hemostasis time in the experimental group was (35.82 ± 12.47) h, and the mean bleeding time in the control group was (49.16 ± 11.58) h. After statistical analysis, t = 10.254, P = 0.000 <0.05, the difference was statistically significant (10.25 ± 7.54) in the experimental group and (13.47 ± 6.73) in the control group. The statistical difference between the two groups was statistically significant (t = 4.538, P = 0.000 <0.005) The portal vein blood flow in the experimental group was (580.34 ± 176.38) ml / min and in the control group was (650.25 ± 142.47) ml / min, the difference was statistically significant (P <0.05); the splenic vein blood flow in the experimental group was (213.36 ± 90.74) ml / min in the control group and (286.74 ± 101.25) ml / min in the control group (P <0.05). After treatment, the diameter of the portal vein and the diameter of the splenic vein in the experimental group were significantly better than those in the control group (P <0.05). Conclusion The clinical efficacy of Huoxue Ruanjian and Huayu Tongluo combined hemostatic in the treatment of patients with cirrhosis and upper gastrointestinal hemorrhage is satisfactory. The hemodynamics of splenic vein and portal vein are improved obviously in patients. The treatment method is simple and feasible and the compliance is high.