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目的探讨微生态制剂联合莫沙必利在预防肝硬化食管胃静脉曲张出血中的临床应用价值。方法选择67例葡萄糖-氢呼气试验(GHBT)阳性的肝硬化(失代偿期)患者随机分为两组,对照组采用传统方法(包括利尿、护肝、输注白蛋白和新鲜血浆、降低门脉高压等)治疗;研究组在采用对照组治疗方法的基础上,口服双歧杆菌三联活菌、莫沙必利治疗12周,治疗前后检测患者内毒素(LPS)、肿瘤坏死因子α(TNF-α)和一氧化氮(NO)水平,同步观察患者血液动力学指标(包括心输出量CO、心脏字数CI、外周血管阻力R和门静脉血流量PVF)和食管曲张静脉直径(EVD)变化。结果治疗前GHBT阳性肝硬化患者血浆LPS、TNF-α和NO水平互相间呈正相关,血浆NO水平与CO、CI、PVE、EVD呈显著性正相关,与R呈显著性负相关;治疗后研究组LPS、TNF-α、NO、CO、CI、R、PVF、EVD与对照组比较有显著差异。结论肝硬化失代偿期患者血浆LPS、TNF-α和NO生成增多,NO在门脉高压形成及血流动力学紊乱中起重要作用;应用微生态制剂联合莫沙必利能有效地降低门脉高压和纠正高动力循环,为预防肝硬化食管胃静脉曲张出血提供一种新思路和有效辅助预防出血的方法。
Objective To investigate the clinical value of probiotics combined with mosapride in the prevention of hepatic cirrhosis with esophageal and gastric variceal bleeding. Methods Sixty-seven patients with hepatocirrhosis (decompensated) who were positive for GHBT were randomly divided into two groups. Patients in the control group were treated with traditional methods (including diuresis, liver protection, albumin infusion and fresh plasma, Reduce portal hypertension and so on); on the basis of the treatment of the control group, the study group was treated with viable Bifidobacterium triple viable bacteria and Mosapride for 12 weeks. Before and after treatment, the levels of endotoxin (LPS), tumor necrosis factor alpha (Including cardiac output CO, cardiac word CI, peripheral vascular resistance R and portal vein blood flow PVF) and esophageal varicose veins diameter (EVD) were observed simultaneously with the levels of TNF-αand NO. Variety. Results The levels of plasma LPS, TNF-α and NO in patients with GHBT positive cirrhosis before treatment were positively correlated with each other. There was a significant positive correlation between plasma NO levels and CO, CI, PVE and EVD, but negatively correlated with R. After treatment The levels of LPS, TNF-α, NO, CO, CI, R, PVF and EVD were significantly different from the control group. Conclusions Plasma LPS, TNF-α and NO production are increased in patients with decompensated liver cirrhosis. NO plays an important role in the formation of portal hypertension and hemodynamic disorders. The application of probiotics together with mosapride can effectively reduce the incidence of portal hypertension High blood pressure and correct high power cycle, to prevent cirrhosis of esophagogastric variceal bleeding provides a new idea and effective in helping to prevent bleeding.