Propranolol combined single-nitro-isosorbide ester prevention efficacy of esophageal variceal bleeding
Propranolol; single nitro isosorbide ester;
variceal bleeding esophageal varices is a serious complication of cirrhosis, the condition dangerous, often life-threatening, therefore,
p90x workout schedule, how to prevent and slow the bleeding is a clinical an important issue. March 2001 - December 2007, we treated 64 patients, respectively, to be oral propranolol and propranolol with isosorbide single nitro ester combined with treatment, the results reported below.
1 objects and methods
1.1 Object
all patients by endoscopy, ultrasound and ct diagnosed with cirrhosis and esophageal varices, liver and kidney function was normal and no heart failure, arrhythmia, and ascites. Observation group, 18 males and 14 females, aged 38 to 55 years,
abercrombie ireland, mean 42 years; the control group 13 males and 19 females, aged 35 to 58 years, an average of 39 years of age. Group ######, age and other basic conditions, no significant difference.
1.2 approach to the control group
oral propranolol, 10 ~ 20 mg, 2 times / d, gradually increase the amount to 40 ~ 90 mg / d; observation group on the basis of the above combined with the treatment Isosorbide single nitro ester 10 mg, 2 times / d, according to reactions of patients after treatment increased to 20 ~ 60 mg / d, long-term oral, not free to change the amount to resting heart rate compared with before treatment 25 % 1, but not less than 55 beats / min.
2 results
observation group and control group, no significant difference in mortality, but the bleeding rate and timing of the first bleeding was significantly lower than the control group, Table 1, there was no follow-up period due to bleeding too large to directly slaughtered, the other two drugs in combination group did not occur with impaired renal function. Table 1 Comparison of two sets of follow-up discussion
propranolol n
3 non-selective β? Blockers,
mbt shoes ireland, which through β1? Receptor blocking effect decreased heart rate, cardiac output; by β2? role of the α receptor blockers exciting, visceral vascular resistance increased, especially in the hepatic artery wall β2? receptor by blocking the hepatic artery contraction, blood flow decreased, so that the portal pressure decreased, while it selectively reduce the odd blood flow, due to azygos vein blood flow through the stomach and upper part of esophageal varices on behalf of blood flow, it reduces the internal pressure and varicose vein wall tension 2. A given propranolol, the hepatic venous pressure gradient decreased by 10% to 31%, long-term administration is decreased by 20% to 38% 1. Isosorbide single nitro ester by direct expansion of portal collateral vascular bed, relaxation fibrous septa and sinusoidal liver anterior muscle fibroblasts, the portal blood flow decreased by 1. After the two-drug combination, the expansion of a single nitro veins of isosorbide esters, reduce portal and collateral vascular resistance, offsetting the increase in propranolol so that adverse effects of propranolol, isosorbide offset single-nitro- ester leaving the heart due to increased sympathetic excitement adverse reactions due to a single nitro-isosorbide esters reduced arterial pressure through pressure receptor-mediated visceral vasoconstriction, further reducing the portal blood flow,
tory burch outlet, thereby reducing the bleeding risk 1.
1 Cham first Paul, Guo-Ming Xu. portal hypertension medication m / / Zhao-Shen Li. Introduction of scientific theory and technology, Shanghai: Second Military Medical University Press ,2001:413-416.
2 XIA all cirrhosis m / / Dai Ziying. Practical in Science. 9th edition .1995:1446.
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