注射用白眉蛇毒血凝酶、生长抑素联合泮托拉唑治疗上消化道出血的疗效观察
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摘要
目的:探讨注射用白眉蛇毒血凝酶、生长抑素联合泮托拉唑治疗上消化道出血的疗效。方法:选取2016年1月至2018年3月阜阳市人民医院收治的上消化道出血患者129例,以随机数字表法分为A、B及C组,每组43例。A组患者给予白眉蛇毒血凝酶、生长抑素联合泮托拉唑治疗,B组患者给予生长抑素联合泮托拉唑治疗,C组患者给予白眉蛇毒血凝酶联合泮托拉唑治疗。比较三组患者的临床疗效、止血时间、住院时间、输血量、出血量、出血次数、柏油便次数、血压、心率、胃液pH、不良反应发生情况及黏膜恢复情况的差异。结果:治疗72 h后,A组患者的总有效率为97.67%(42/43),明显高于B组的83.72%(36/43)和C组的81.40%(35/43),差异均有统计学意义(P<0.05);而B、C组患者总有效率的差异无统计学意义(P>0.05)。治疗后,A组患者的止血时间、住院时间明显短于B、C组,输血量、出血量、出血次数及柏油便次数明显少于B、C组,差异均有统计学意义(P<0.05);而B、C组患者上述指标的差异均无统计学意义(P>0.05)。三组患者治疗前后的血压(收缩压、舒张压)、心率的差异无统计学意义(P>0.05);治疗后,A组患者胃液pH明显高于B、C组,差异有统计学意义(P<0.05)。A、B及C组患者不良反应发生率分别为11.6%(5/43)、14.0%(6/43)及7.0%(3/43),差异均无统计学意义(P>0.05)。治疗后,A组患者内镜下黏膜恢复情况明显优于B组和C组。结论:注射用白眉蛇毒血凝酶、生长抑素联合泮托拉唑治疗上消化道出血的疗效显著,能有效控制患者急性出血,为抢救赢得时间,同时有利于改善患者预后。
OBJECTIVE: To probe into the efficacy of hemocoagulase for injection combined with somatostatin and pantoprazole in treatment of upper gastrointestinal hemorrhage. METHODS: 129 patients with upper gastrointestinal hemorrhage admitted into People's Hospital of Fuyang from Jan. 2016 to Mar. 2018 were selected and divided into group A, group B and group C via random number table, with 43 cases in each group. Group A was given hemocoagulase for injection combined with somatostatin and pantoprazole, group B was given somatostatin combined with pantoprazole, group C was given hemocoagulase for injection combined with pantoprazole. Differences in clinical efficacy, time of bleeding stopping, hospital stays, volume of blood transfusion, amount of bleeding, frequency of bleeding, frequency of tarry stool, blood pressure, heart rate, pH of gastric juice, incidences of adverse drug reactions and recovery of mucous membrane among three groups were compared. RESULTS: At 72 h after treatment, the total effective rate of group A was 97.67%(42/43), which was significantly higher than that of group B(83.72%, 36/43) and group C(81.40%, 35/43), with statistically significant differences(P<0.05); and there was no statistical significance in difference of total effective rates between group B and group C(P>0.05). After treatment, the time of bleeding stopping and hospital stays of patients in group A were significantly shorter than those in group B and C, and the volume of blood transfusion, amount of bleeding, frequency of bleeding and frequency of tarry stool were significantly less than those in group B and C, with statistically significant differences(P<0.05); and there was no significant difference in the above indexes between group B and group C(P>0.05). There was no significant difference in blood pressure(systolic blood pressure, diastolic blood pressure) and heart rate among the three groups before and after treatment(P>0.05). After treatment, the pH of gastric juice in group A was significantly higher than that in group B and C, and the difference was statistically significant(P<0.05). The incidence of adverse drug reactions in group A, B and C were 11.6%(5/43), 14.0%(6/43) and 7.0%(3/43), respectively, and the difference was not statistically significant(P>0.05). After treatment, the endoscopic recovery of mucosa in group A was significantly better than that in group B and C. CONCLUSIONS: The efficacy of hemocoagulase for injection combined with somatostatin and pantoprazole in treatment of upper gastrointestinal hemorrhage is significant, which can effectively control the acute bleeding of patients, save time for rescue and improve the prognosis of patients.
OBJECTIVE: To probe into the efficacy of hemocoagulase for injection combined with somatostatin and pantoprazole in treatment of upper gastrointestinal hemorrhage. METHODS: 129 patients with upper gastrointestinal hemorrhage admitted into People's Hospital of Fuyang from Jan. 2016 to Mar. 2018 were selected and divided into group A, group B and group C via random number table, with 43 cases in each group. Group A was given hemocoagulase for injection combined with somatostatin and pantoprazole, group B was given somatostatin combined with pantoprazole, group C was given hemocoagulase for injection combined with pantoprazole. Differences in clinical efficacy, time of bleeding stopping, hospital stays, volume of blood transfusion, amount of bleeding, frequency of bleeding, frequency of tarry stool, blood pressure, heart rate, pH of gastric juice, incidences of adverse drug reactions and recovery of mucous membrane among three groups were compared. RESULTS: At 72 h after treatment, the total effective rate of group A was 97.67%(42/43), which was significantly higher than that of group B(83.72%, 36/43) and group C(81.40%, 35/43), with statistically significant differences(P<0.05); and there was no statistical significance in difference of total effective rates between group B and group C(P>0.05). After treatment, the time of bleeding stopping and hospital stays of patients in group A were significantly shorter than those in group B and C, and the volume of blood transfusion, amount of bleeding, frequency of bleeding and frequency of tarry stool were significantly less than those in group B and C, with statistically significant differences(P<0.05); and there was no significant difference in the above indexes between group B and group C(P>0.05). There was no significant difference in blood pressure(systolic blood pressure, diastolic blood pressure) and heart rate among the three groups before and after treatment(P>0.05). After treatment, the pH of gastric juice in group A was significantly higher than that in group B and C, and the difference was statistically significant(P<0.05). The incidence of adverse drug reactions in group A, B and C were 11.6%(5/43), 14.0%(6/43) and 7.0%(3/43), respectively, and the difference was not statistically significant(P>0.05). After treatment, the endoscopic recovery of mucosa in group A was significantly better than that in group B and C. CONCLUSIONS: The efficacy of hemocoagulase for injection combined with somatostatin and pantoprazole in treatment of upper gastrointestinal hemorrhage is significant, which can effectively control the acute bleeding of patients, save time for rescue and improve the prognosis of patients.
引文
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[11] 李建周,仲盛年.内镜止血技术在上消化道出血中的临床实践[J].实用临床医药杂志,2015,19(13):80-82.
[12] 吴咏冬.胃内pH值控制在治疗上消化道出血中的作用[J].中华内科杂志,2016,55(5):398-399.
[13] Fabricius R,Svenningsen P,Hillings? J,et al.Effect of Transfusion Strategy in Acute Non-variceal Upper Gastrointestinal Bleeding: A Nationwide Study of 5861 Hospital Admissions in Denmark[J].World J Surg,2016,40(5):1129-1136.
[14] 贺继东,王莉.白眉蛇毒血凝酶与巴西矛头蝮蛇毒血凝酶治疗消化性溃疡致出血的疗效比较[J].实用临床医药杂志,2014,18(21):192-193.
[15] 翟丽华,王启仪,沙卫红,等.不同剂量泮托拉唑对消化性溃疡并出血高危患者胃内pH的影响[J].新医学,2015,46(4):254-258.
[16] 王丰平,张永龙.乌司他丁联合生长抑素治疗急性重症胰腺炎疗效观察[J].中国药师,2014,17(5):812-814.
[2] Rassameehiran S,Teerakanok J,Suchartlikitwong S,et al.Utility of the Shock Index for Risk Stratification in Patients with Acute Upper Gastrointestinal Bleeding[J].South Med J,2017,110(11):738-743.
[3] Yarze JC,Tadros M.Upper Gastrointestinal Bleeding Due to a Peptic Ulcer[J].N Engl J Med,2016,375(12):1197.
[4] Xiang TG,Liu GX,Li T.An Unusual Cause of Life-threatening Upper Gastrointestinal Bleeding[J].Gastroenterology,2016,151(3):400-402.
[5] 徐伟仙,陈颖,华尉利,等.阿司匹林和质子泵抑制剂固定复方制剂的立题合理性探讨[J].中国临床药理学杂志,2016,32(5):466-468.
[6] 刘晓萍,白雪峰.泮托拉唑联合生长抑素治疗食管胃底静脉曲张性上消化道出血的临床疗效观察[J].药物评价研究,2016,39(5):844-847.
[7] Nephew LD,Goldberg DS.Impact of Anticoagulation on Upper Gas-trointestinal Bleeding in Cirrhosis[J].Gastroenterology,2016,150(5):1239-1241.
[8] 刘北京,宋建华,王丽双.泮托拉唑持续泵入用于非静脉曲张性上消化道出血止血效果观察[J].山东医药,2014,54(26):105.
[9] Lee KE,Shim KN,Tae CH,et al.Multidisciplinary Approach to Ref-ractory Upper Gastrointestinal Bleeding: Case Series of Angiographic Embolization[J].J Korean Med Sci,2017,32(9):1552-1557.
[10] Rahman SI,Saeian K.Nonvariceal Upper Gastrointestinal Bleeding[J].Crit Care Clin,2016,32(2):223-239.
[11] 李建周,仲盛年.内镜止血技术在上消化道出血中的临床实践[J].实用临床医药杂志,2015,19(13):80-82.
[12] 吴咏冬.胃内pH值控制在治疗上消化道出血中的作用[J].中华内科杂志,2016,55(5):398-399.
[13] Fabricius R,Svenningsen P,Hillings? J,et al.Effect of Transfusion Strategy in Acute Non-variceal Upper Gastrointestinal Bleeding: A Nationwide Study of 5861 Hospital Admissions in Denmark[J].World J Surg,2016,40(5):1129-1136.
[14] 贺继东,王莉.白眉蛇毒血凝酶与巴西矛头蝮蛇毒血凝酶治疗消化性溃疡致出血的疗效比较[J].实用临床医药杂志,2014,18(21):192-193.
[15] 翟丽华,王启仪,沙卫红,等.不同剂量泮托拉唑对消化性溃疡并出血高危患者胃内pH的影响[J].新医学,2015,46(4):254-258.
[16] 王丰平,张永龙.乌司他丁联合生长抑素治疗急性重症胰腺炎疗效观察[J].中国药师,2014,17(5):812-814.