特利加压素联合内镜静脉曲张套扎术预防急性食管静脉曲张破裂再出血的研究

背景：食管胃底静脉曲张破裂出血是肝硬化的危重并发症之一，内镜静脉曲张套扎术（EVL）是食管静脉曲张破裂出血的首选内镜治疗方案。对于急性食管静脉曲张破裂出血患者，推荐于EVL术后使用血管活性药物特利加压素3—5d以预防早期再出血。目的：明确特利加压素联合EVL对急性食管静脉曲张破裂再出血的预防作用。方法：96例急诊食管静脉曲张破裂出血患者行EVL后随机分为2组，对照组口服普萘洛尔10mg／d×5d，干预组静脉推注特利加压素1mg／d×5d，其后两组患者均以维持剂量长期服用普萘洛尔。记录术后5d内和3个月内的再出血发生情况。结果：干预组早期（5d内）再出血率显著低于对照组（2．1％对12．5％，P〈0．05），两组近期（3个月内）再出血率无明显差异（4．2％对14．6％，P〉0．05）。结论：急诊EVL联合特利加压素预防急性食管静脉曲张破裂早期再出血的效果优于EVL联合普萘洛尔，远期结果尚需进一步随访观察。

Terlipressin in Combination with Endoscopic Variceal Ligation for Prevention of Acute Esophageal Variceal Rebleeding

Background： Esophageal and gastric variceal bleeding is a critical complication in patients with liver cirrhosis. Endoscopic variceal ligation （EVL） is the endoscopic hemostatic treatment of first choice for esophageal variceal bleeding. For acute esophageal variceal bleeding, vasoactive drugs （preferably terlipressin） maintained for 3-5 days after EVL is recommended for prevention of early rebleeding. Aims ： To investigate the effect of terlipressin in combination with EVL for prevention of acute esophageal variceal rebleeding. Methods： Ninety-six acute esophageal variceal bleeding patients undergoing EVL were randomly divided into two groups. Patients in control group were administered with oral propranolol 10 mg/d for 5 days, while patients in intervention group received terlipressin 1 mg/d i.v. for 5 days. After the 5-day treatment course, patients in both groups were given propranolol for long term maintenance therapy. Rebleeding occurred within 5-day and 3-month was recorded in both groups. Results： Early （5-day） rebleeding rate was significantly lower in intervention group than in control group （2.1% vs. 12.5%, P 〈0.05）, while no significant difference was demonstrated in short term （3-month） rebleeding rate between the two groups （4. 2% vs. 14. 6%, P 〉 0.05）. Conclusions： Emergency EVL combined with terlipressin is superior to EVL combined with propranolol for prevention of acute esophageal variceal early rebleeding. Its long term efficacy needs to be further explored.