發(fā)布時間：2018-05-27 12:17

  本文選題：門脈高壓性胃病 + 治療��； 參考：《山東大學》2014年碩士論文

【摘要】：研究背景與目的 隨著內(nèi)窺鏡的發(fā)展及其在臨床的廣泛應(yīng)用,門脈高壓性胃病(Portal Hypertensive Gastropathy, PHG)引起越來越多的關(guān)注。雖然到目前為止就其發(fā)病機制仍未達成共識,但國內(nèi)外研究普遍認為門靜脈壓力的升高是門脈高壓性胃病存在的重要條件。而非選擇性p受體阻滯劑(Nonselective beta blocker, NSBB)普萘洛爾是臨床上用于降低門靜脈壓力的首選藥物,同時也是推薦用于門脈高壓性胃病出血治療的首選藥物；但有關(guān)普萘洛爾在門脈高壓性胃病治療中的臨床研究仍很少。而新型非選擇性p受體阻斷劑——卡維地洛同樣具有較強的非選擇性p受體阻滯作用,同時具有一定的拮抗α1受體的作用,其在門脈高壓的治療作用可能優(yōu)于普萘洛爾,但目前關(guān)于卡維地洛在門脈高壓性胃病治療中的研究資料十分缺乏。同時普萘洛爾與卡維地洛對門脈高壓性胃病的療效的對比研究資料十分稀少,對于兩者在門脈高壓性胃病的治療中是否存在差異仍缺乏足夠的研究支持。本研究主要為了探究門脈高壓性胃病與門靜脈壓力之間所存在的關(guān)系；同時研究非選擇性p受體阻滯劑——普萘洛爾及卡維地洛在門脈高壓性胃病治療中的作用及其兩者間療效的比較。 研究方法 本研究收集山東大學附屬山東省立醫(yī)院東院內(nèi)鏡中心2010年4月-2014年3月所有經(jīng)胃鏡檢查證實門脈高壓性胃病、既往無消化道出血病史、并住院行肝靜脈壓力梯度測定(Hepatic Venous Pressure Gradient, HVPG)檢測的患者為研究對象。符合條件的所有患者分為3組：A組為未服用非選擇性β受體阻斷劑的患者,B組為服用普萘洛爾的患者,C組為服用卡維地洛的患者。并對入組患者進行詳細的記錄,包括：年齡、性別、肝靜脈壓力梯度(HVPG).肝功、腎功能及門脈高壓性胃病Baveno[3]評分[4]分值。對比各組患者門脈高壓性胃病Baveno分值前后變化,并且分析各組內(nèi)使用藥物前后門脈高壓性胃病嚴重程度的差異。初始門脈高壓性胃病為PHG1,3月后門脈高壓性胃病分值為PHG2,用藥前后分值變化PHG3=PHG2-PHG1;同時對比用藥組與對照組間的PHG3差異,分析門脈高壓性胃病與用藥的關(guān)系；具體設(shè)計流程圖(見附圖1)。結(jié)果運用SPSS v20.0中文版軟件包對所統(tǒng)計數(shù)據(jù)進行分析。 結(jié)果 本研究資料齊全患者60例,A組19例,初始門脈高壓性胃病Baveno分值PHG1=1.74±1.10,3月后復(fù)查時門脈高壓性胃病Baveno分值PHG2=3.16±0.90; P=0.26, P0.05,無統(tǒng)計學意義；B組14例,初始門脈高壓性胃病Baveno分值PHG1=3.36±1.65,3月后復(fù)查時門脈高壓性胃病Baveno分值PHG2=2.57±1.45:P=0.02, P0.05,有統(tǒng)計學意義。C組27例,初始門脈高壓性胃病Baveno分值PHG1=2.56±1.34,3月后復(fù)查時門脈高壓性胃病Baveno分值PHG2=1.63±1.71; P=0.00, P0.05,有統(tǒng)計學意義。A組PHG3=1.42±1.22,B組PHG3=-0.79±1.37,C組PHG3=-0.93±1.30;A組和B組比較：P=0.00,P0.05,有統(tǒng)計學意義；A組和C組比較：P=0.00,P0.05,有統(tǒng)計學意義；B組合C組比較,P=0.94,P0.05,無統(tǒng)計學意義。 結(jié)論 1.門靜脈壓力增高是門脈高壓性胃病的重要條件,但并非唯一條件；同時門靜脈壓力的高低與門脈高壓性胃病的嚴重程度不存在線性關(guān)系。 2.非選擇β受體阻滯劑——普萘洛爾及卡維地洛均能顯著降低門脈高壓性胃病的嚴重程度。 3.普萘洛爾及卡維地洛在降低門脈高壓性胃病的嚴重程度方面無顯著差異。
[Abstract]:Research background and purpose
With the development of endoscopy and its wide application in clinical practice, Portal Hypertensive Gastropathy (PHG) has attracted more and more attention. Although no consensus has been reached on its pathogenesis so far, it is generally believed that the increase of portal pressure is an important condition for the existence of portal hypertensive gastropathy. The non selective P receptor blocker (Nonselective beta blocker, NSBB) propranolol is the first drug used to reduce portal pressure and is also recommended for the treatment of portal hypertensive gastropathy. However, there are few clinical studies on propranolol in the treatment of portal hypertensive gastropathy. The Selective P receptor blocker, carvedilol, also has a strong non selective P receptor blocking effect and has a certain antagonistic effect on the alpha 1 receptor. The therapeutic effect of carvedilol on the portal hypertension may be better than propranolol, but the current research on carvedilol in the treatment of portal hypertensive gastropathy is very short. The comparative study of the curative effect of carvedilol and carvedilol on portal hypertensive gastropathy is very rare. There is still a lack of sufficient research support for the difference between the two in the treatment of portal hypertensive gastropathy. This study is mainly to explore the relationship between portal hypertension and portal vein pressure. The role of Selective P receptor blocker propranolol and carvedilol in the treatment of portal hypertensive gastropathy and the comparison between them.
research method
This study collected all the patients in the endoscopy center of the Eastern Hospital of Shandong University, Shandong University, in March -2014 April 2010. All patients who had been examined by gastroscopy proved portal hypertensive gastropathy, had no history of hemorrhage in the digestive tract, and were detected by Hepatic Venous Pressure Gradient, HVPG in hospitalized patients. All patients were divided into 3 groups: the A group was a patient who did not take the non selective beta blocker, the B group was taken propranolol, the C group was taken carvedilol, and the patients in the group were recorded in detail, including age, sex, liver vein pressure gradient (HVPG), liver function, renal function, and portal hypertensive gastropathy, Baveno[3] score [4] The changes in the Baveno score of the portal hypertensive gastropathy in each group were compared, and the difference in the severity of portal hypertensive gastropathy was analyzed before and after the use of drugs. The value of the initial portal hypertensive gastropathy was PHG2 after PHG1,3 months, and the score of PHG3=PHG2-PHG1 before and after the drug use was changed; at the same time, the drug group and the control were compared. The PHG3 difference between groups was used to analyze the relationship between portal hypertensive gastropathy and drug use; specific design flow chart (see Figure 1). Results the statistical data were analyzed with the Chinese version of SPSS v20.0 software package.
Result
There were 60 patients with complete data in this study and 19 cases in group A. The value of Baveno of initial portal hypertensive gastropathy was PHG1=1.74 + 1.10,3 months after PHG1=1.74 + 1.10,3 months. The value of Baveno of portal hypertensive gastropathy was PHG2=3.16 + 0.90; P=0.26, P0.05, no statistical significance; 14 cases in group B, Baveno of initial portal hypertensive gastropathy in PHG1=3.36 + 1.65,3 month review The score of Baveno was PHG2=2.57 + 1.45:P=0.02 and P0.05. There were 27 cases in group.C with statistical significance. The Baveno score of initial portal hypertensive gastropathy was PHG1=2.56 + 1.34,3 months after PHG1=2.56 + 1.34,3 months. The Baveno score of portal hypertensive gastropathy was PHG2=1.63 + 1.71; P=0.00, P0.05. Group comparison: P=0.00, P0.05, there was statistical significance; A group and C group: P=0.00, P0.05, there was statistical significance; B combination C group comparison, P=0.94, P0.05, no statistical significance.
conclusion
The increased pressure of 1. portal veins is an important condition for portal hypertensive gastropathy, but it is not the only condition. There is no linear relationship between the pressure of portal vein and the severity of portal hypertensive gastropathy.
2. no choice of beta blockers propranolol and carvedilol can significantly reduce the severity of portal hypertensive gastropathy.
3. there was no significant difference in the severity of portal hypertensive gastropathy between propranolol and carvedilol.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R573.9

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本文編號：1942030