| Background and Objective:In cirrhotic patients, esophageal variceal bleeding(EVB) is a serious and common complication. it’s characterized by acute onset、high risk and high death rate. According to research,The mortality of first bleeding patients is between 20% and 40%, in the follow 2 years,the rebleeding rate can reach as high as 70%, is the leading cause of death in cirrhotic patients.The majority of cirrhotic patients will eventually form the stomach esophagus varicose veins,the scale is as high as 60% of patients accompanied by ascites.So how to effectively prevent varicosity burst hemorrhage is an important topic.Drugs play important roles in the first variceal bleeding in patients with cirrhosis,non-selective beta blockers is currently the main drugs recommended to reduce portal vein pressure.Traditional NSBB like propranolol is widely used in clinical primary prophylaxis of variceal bleeding.Carvedilol is the third generation of β blockers,it’s a potent non-selective beta-blockers and weak a 1 receptor blockers,it was found to be 2-4 times more efficacy than propranolol as a NSBB.Recently many hemodynamic studies show carvedilol is more effective than propranolol in reduce the portal vein pressure,but at the respect to preventing varices bleeding, there is no direct clinical evidence can confirm carvedilol is more effective than propranolol.This study aims to compare the efficacy,compliance and safety of carvedilol and propranolol for preventing the first time esophageal gastric varices bleeding in patients with cirrhosis.Methods:This study selected 53 cases of liver cirrhosis patients with esophageal varices from June 2010 to September 2015 in our hospital, divided into carvedilol group and propranolol group randomly, followed up these patients, observe and compare the incidence of first variceal bleeding,adverse reactions or complications and compliance of patient.Results:The basal conditions in each group before treatment were comparable, the average follow-up time of carvedilol group and propranolol group were 30.93m ± 21.45m,35.21m±18.95m respectively, there was no statistically significant difference between the two groups (P> 0.05);In the aspect of drug compliance, carvedilol group was superior to propranolol group significantly(96.9% vs 76.2% p=0.02<0.05); First varices bleeding rate (9.38% vs 14.29%) and survival time (57.63 m±3.35 m vs.61.78 m±4.24 m, P> 0.05) of the two groups don’t show significant differences (P> 0.05);there has also no significant differences between incidences of complications and adverse reaction of the two groups (9.38% vs 14.29%, P=0.581> 0.05), both without serious adverse events.Conclusions:Carvedilol and propranolol are effective and safe in primary prophylaxis of bleeding among cirrhosis patients with high risk of hemorrhage, In the patient’s medication adherence carvedilol was significantly superior to propranolol, both in the prevention of bleeding and incidence of adverse reactions has no significant difference, but more high quality trials with larger sample size and longer follow-up are needed to further confirmed。... |
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