卡维地洛联合托伐普坦片治疗肝硬化合并食管胃底静脉曲张效果观察

目的 探讨卡维地洛联合托伐普坦片治疗肝硬化合并食管胃底静脉曲张患者临床疗效。方法 选取2018年1月—2020年7月本院收治的肝硬化合并食管胃底静脉曲张患者86例,根据随机数表法分为联合组和托伐普坦组各43例,托伐普坦组给予托伐普坦治疗,联合组患者在此基础上给予卡维地洛进行联合治疗,两组均以三个月为一疗程。比较两组患者平均动脉压和心率水平,并比较治疗前后两组患者肝肾功能和肝静脉压力梯度(Hepatic Venous Pressure Gradient,HVPG)水平,观察两组患者治疗过程中不良反应发生情况。结果 治疗前,两组患者平均动脉压和心率水平差异均无统计学意义(P>0.05);治疗后联合组平均动脉压和心率分别为(85.69±15.58)mm Hg、(76.52±8.06)次/分,低于对照组的(97.51±17.52)mm Hg 、(85.73±9.11)次/分,差异有统计学意义(t=3.306、4.965,P值均<0.05)。治疗后联合组患者HVPG为(10.41±1.74)mm Hg,低于托伐普坦组的(12.73±1.98)mm Hg,(t=5.772,P<0.001)。联合组不良反应发生率为30.23%,托伐普坦组为34.88%,两组比较差异无统计学意义(χ2=0.212,P=0.645)。结论 卡维地洛联合托伐普坦片治疗肝硬化合并食管胃底静脉曲张患者临床疗效显著,可显著缓解患者门静脉高压,且无不良反应增加,值得临床进一步推广应用。

Effect of carvedilol combined with tovaptan tablets on liver cirrhosis complicated with esophageal and gastric varices

Objective To investigate the clinical efficacy of carvedilol combined with tovaptan tablets in the treatment of patients with liver cirrhosis complicated with esophageal and gastric varices. Methods A total of 86 patients with liver cirrhosis complicated with esophagogastric varices treated in our hospital from January 2018 to July 2020 were randomly divided into a combined group and a tovaptan group, with 43 cases in each group. The tovaptan group was treated with tovaptan, and the patients in the combined group were treated with carvedilol on the basis of the tovaptan group. Both groups took three months as a course of treatment. The mean arterial pressure and heart rate of the two groups were investigated and compared, and the liver function, kidney function, and hepatic venous pressure gradient (HVPG) levels of the two groups before and after treatment were investigated and compared. The adverse reactions of the two groups during the treatment were also observed. Results Before the treatment, there was no significant difference in mean arterial pressure and heart rate between the two groups (P>0.05); after the treatment, the mean arterial pressure and heart rate in the combined group were (85.69±15.58) mm Hg and (76.52±8.06) bPm respectively, lower than those in the control group: (97.51±17.52) mm Hg and (85.73±9.11) bPm respectively, and the differences were statistically significant (t=3.306, 4.965, both P<0.05). After the treatment, the HVPG in the combined group was (10.41±1.74) mm Hg, which was lower than (12.73±1.98) mm Hg in the tovaptan group (t=5.772, P<0.001). The incidence of adverse reactions in the combination group was 30.23% and that in the tovaptan group was 34.88%, and there was no significant difference between the two groups (χ2=0.212, P=0.645). Conclusion Carvedilol combined with tovaptan tablets has a significant clinical effect in the treatment of patients with cirrhosis complicated with esophageal and gastric varices. It can significantly alleviate portal hypertension without increased adverse reactions. It is worthy of further clinical application.