生长抑素对肝硬化食管胃底静脉曲张破裂出血患者血流动力学指标及胃肠激素水平的影响
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摘要
目的探讨生长抑素对肝硬化食管胃底静脉曲张破裂出血(esophageal and gastric variceal bleeding,EGVB)患者血流动力学指标及胃肠激素水平的影响。方法选择82例肝硬化EGVB作为研究对象,采用随机数字表法随机将其分为观察组42例和对照组40例,观察组在常规治疗基础上采用生长抑素进行治疗,对照组在常规治疗基础上采用特利加压素进行治疗。比较两组止血时间、输血量、再出血率,治疗前后血流动力学指标和血清胃肠激素水平,以及治疗期间不良反应发生情况。结果观察组止血时间短于对照组,差异有统计学意义(P <0. 05)。两组治疗前后门静脉压(PVP)及血清胃动素(MTL)、胃泌素(GAS)、胰高血糖素(GLC)、生长抑素(SS)水平总体比较差异有统计学意义(P <0. 05)。治疗后两组PVP及血清MTL、GAS、GLC、SS水平均呈降低趋势,PVP及血清MTL、GAS、GLC、SS水平治疗后12 h、治疗后24 h、治疗后48 h及治疗后72 h与治疗前比较差异均有统计学意义(P <0. 05)。两组间治疗前后中心静脉压(CVP)、PVP及血清MTL、GAS、GLC、SS水平比较差异均无统计学意义(P> 0. 05)。治疗期间观察组不良反应总发生率11. 90%明显低于对照组不良反应总发生率70. 00%,差异有统计学意义(P <0. 05)。结论生长抑素和特利加压素治疗肝硬化EGVB效果相当,但生长抑素治疗肝硬化EGVB止血速度更快,不良反应发生率更低。
Objective To explore the effects of somatostatin on hemodynamic parameters and levels of gastrointestinal hormones in cirrhotic patients with esophageal and gastric variceal bleeding( EGVB). Methods Eighty-two cirrhotic patients with EGVB were selected as the research subjects. They were randomly divided into observation group( n =42) and control group( n =40). The observation group was treated with somatostatin on the basis of conventional treatment,while the control group was treated with terlipressin on the basis of conventional treatment. Duration of hemostasis,blood transfusion volume,rebleeding rate,hemodynamic parameters and gastrointestinal hormone levels before and after treatment,and adverse reactions during treatment were compared between the two groups. Results The duration of hemostasis of the observation group was shorter than that of the control group,and significant differences were found( P < 0. 05). There were significant differences in portal vein pressure( PVP),serum motilin( MTL),gastrin( GAS),glucagon( GLC) and somatostatin( SS) levels between the two groups before and after treatment( P <0. 05). After treatment,the levels of PVP and serum MTL,GAS,GLC and SS in both groups showed a decreasing trend. The levels of PVP and serum MTL,GAS,GLC and SS at 12,24,48 and 72 h after treatment were significantly different from those before treatment( P < 0. 05). There was no significant difference in central venous pressure( CVP),PVP,serum MTL,GAS,GLC and SS levels between the two groups before and after treatment( P >0. 05).The total incidence of adverse reactions in the observation group was 11. 90%,which was lower than that in the control group( 70. 00%),and the difference was statistically significant( P < 0. 05). Conclusion Somatostatin and terlipressin have similar effects in the treatment of cirrhotic patients with EGVB. However,the hemostasis speed of somatostatin in treating cirrhotic patients with EGVB is faster and the incidence of adverse reactions is lower.
Objective To explore the effects of somatostatin on hemodynamic parameters and levels of gastrointestinal hormones in cirrhotic patients with esophageal and gastric variceal bleeding( EGVB). Methods Eighty-two cirrhotic patients with EGVB were selected as the research subjects. They were randomly divided into observation group( n =42) and control group( n =40). The observation group was treated with somatostatin on the basis of conventional treatment,while the control group was treated with terlipressin on the basis of conventional treatment. Duration of hemostasis,blood transfusion volume,rebleeding rate,hemodynamic parameters and gastrointestinal hormone levels before and after treatment,and adverse reactions during treatment were compared between the two groups. Results The duration of hemostasis of the observation group was shorter than that of the control group,and significant differences were found( P < 0. 05). There were significant differences in portal vein pressure( PVP),serum motilin( MTL),gastrin( GAS),glucagon( GLC) and somatostatin( SS) levels between the two groups before and after treatment( P <0. 05). After treatment,the levels of PVP and serum MTL,GAS,GLC and SS in both groups showed a decreasing trend. The levels of PVP and serum MTL,GAS,GLC and SS at 12,24,48 and 72 h after treatment were significantly different from those before treatment( P < 0. 05). There was no significant difference in central venous pressure( CVP),PVP,serum MTL,GAS,GLC and SS levels between the two groups before and after treatment( P >0. 05).The total incidence of adverse reactions in the observation group was 11. 90%,which was lower than that in the control group( 70. 00%),and the difference was statistically significant( P < 0. 05). Conclusion Somatostatin and terlipressin have similar effects in the treatment of cirrhotic patients with EGVB. However,the hemostasis speed of somatostatin in treating cirrhotic patients with EGVB is faster and the incidence of adverse reactions is lower.
引文
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[3]黄国敏,马明远,庄志浩,等.三腔二囊管联合自制食道囊上注吸管在治疗食管胃底静脉曲张破裂出血中的应用[J].中华危重病急救医学,2013,25(9):554-555.
[4] Arne G,Nilsson B,Dalmo J,et al. Gastrointestinal stromal tumors(GISTs)express somatostatin receptors and bind radiolabeled somatostatin analogs[J].Acta Oncol,2013,52(4):783-792.
[5] Kim H Y,Park J W,Joo J,et al. Worse outcome of sorafenib therapy associated with ascites and ChildPugh score in advanced hepatocellular carcinoma[J].J Gastroenterol Hepatol,2013,28(11):1756-1761.
[6]匿名.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324.
[7]吴志勇,陈炜.肝硬化门静脉高压症围术期处理策略[J].中华消化外科杂志,2016,15(7):661-664.
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[10] Hidaka H,Nakazawa T,Wang G,et al. Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation:a randomized,controlled trial[J]. J Gastroenterol,2012,47(2):118-126.
[11]赵冬梅,安红军,贾珊珊,等.套扎环、组织胶及硬化剂治疗食管胃底静脉曲张的方案选择及其效果[J].中国组织工程研究与临床康复,2011,15(21):3961-3964.
[12]彭芸.特利加压素联合内镜静脉曲张套扎术预防急性食管静脉曲张破裂再出血的研究[J].胃肠病学,2013,18(10):613-614,640.
[13] Hiremath S B,Srinivas L D. Survival benefits of terlipressin and non-responder state in hepatorenal syndrome:A meta-analysis[J]. Indian J Pharmacol,2013,45(1):54-60.
[14] Azam Z,Hamid S,Jafri W,et al. Short course adjuvant terlipressin in acute variceal bleeding:A randomized double blind dummy controlled trial[J]. J Hepatol,2012,56(4):819-824.
[15]刘志娟,张艳华.国产生长抑素治疗肝硬化食管胃底静脉曲张急性出血56例疗效观察[J].内科急危重症杂志,2011,17(5):287-289.
[16] Kalambokis G N,Pappas K,Tsianos E V. Differential effects of terlipressin on pulmonary and systemic hemodynamics in patients with cirrhosis and pulmonary hypertension:An echo study[J]. Angiology,2012,63(3):199-205.
[17]王军,彭浩.特利加压素联合生长抑素治疗肝硬化食管胃底静脉曲张破裂出血疗效观察[J].实用肝脏病杂志,2015,18(4):418-419.
[18]徐晓琦,李民,曹卫菊,等.加味瓜蒌散对肝硬化门静脉高压症患者胃肠激素、肝纤维化指标和血流动力学的影响[J].中西医结合肝病杂志,2009,19(2):70-72.
[19] Ghosh S,Choudhary N S,Sharma A K,et al. Noradrenaline vs terlipressin in the treatment of type 2hepatorenal syndrome:a randomizedpilot study[J].Liver Int,2013,33(8):1187-1193.
[20] Wang C,Han J,Xiao L,et al. Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of earlyvariceal rebleeding after the initial control of bleeding:a systematic review and meta-analysis[J]. Hepatol Int,2015,9(1):120-129.
[21]王琼,王景,邓菁,等.生长抑素和特利加压素单用或联用治疗肝硬化上消化道出血成本-效果分析[J].中国现代医生,2015,53(28):49-52.
[2] Sakamoto Y,Oho K,Toyonaga A,et al. Effect of Helicobacter pylori infection on esophagogastric variceal bleeding in patients with liver cirrhosis and portal hypertension[J]. J Gastroenterol Hepatol,2013,28(9):1444-1449.
[3]黄国敏,马明远,庄志浩,等.三腔二囊管联合自制食道囊上注吸管在治疗食管胃底静脉曲张破裂出血中的应用[J].中华危重病急救医学,2013,25(9):554-555.
[4] Arne G,Nilsson B,Dalmo J,et al. Gastrointestinal stromal tumors(GISTs)express somatostatin receptors and bind radiolabeled somatostatin analogs[J].Acta Oncol,2013,52(4):783-792.
[5] Kim H Y,Park J W,Joo J,et al. Worse outcome of sorafenib therapy associated with ascites and ChildPugh score in advanced hepatocellular carcinoma[J].J Gastroenterol Hepatol,2013,28(11):1756-1761.
[6]匿名.病毒性肝炎防治方案[J].中华肝脏病杂志,2000,8(6):324.
[7]吴志勇,陈炜.肝硬化门静脉高压症围术期处理策略[J].中华消化外科杂志,2016,15(7):661-664.
[8] Liang T J,Chen Y C,Liang H L,et al. Balloonoccluded retrograde transvenous obliteration for intractable gastric variceal bleeding[J]. J Formos Med Assoc,2013,112(7):426-429.
[9] Bosch J. Carvedilol for preventing recurrent variceal bleeding:Waiting for convincing evidence[J]. Hepatology,2013,57(4):1665-1667.
[10] Hidaka H,Nakazawa T,Wang G,et al. Long-term administration of PPI reduces treatment failures after esophageal variceal band ligation:a randomized,controlled trial[J]. J Gastroenterol,2012,47(2):118-126.
[11]赵冬梅,安红军,贾珊珊,等.套扎环、组织胶及硬化剂治疗食管胃底静脉曲张的方案选择及其效果[J].中国组织工程研究与临床康复,2011,15(21):3961-3964.
[12]彭芸.特利加压素联合内镜静脉曲张套扎术预防急性食管静脉曲张破裂再出血的研究[J].胃肠病学,2013,18(10):613-614,640.
[13] Hiremath S B,Srinivas L D. Survival benefits of terlipressin and non-responder state in hepatorenal syndrome:A meta-analysis[J]. Indian J Pharmacol,2013,45(1):54-60.
[14] Azam Z,Hamid S,Jafri W,et al. Short course adjuvant terlipressin in acute variceal bleeding:A randomized double blind dummy controlled trial[J]. J Hepatol,2012,56(4):819-824.
[15]刘志娟,张艳华.国产生长抑素治疗肝硬化食管胃底静脉曲张急性出血56例疗效观察[J].内科急危重症杂志,2011,17(5):287-289.
[16] Kalambokis G N,Pappas K,Tsianos E V. Differential effects of terlipressin on pulmonary and systemic hemodynamics in patients with cirrhosis and pulmonary hypertension:An echo study[J]. Angiology,2012,63(3):199-205.
[17]王军,彭浩.特利加压素联合生长抑素治疗肝硬化食管胃底静脉曲张破裂出血疗效观察[J].实用肝脏病杂志,2015,18(4):418-419.
[18]徐晓琦,李民,曹卫菊,等.加味瓜蒌散对肝硬化门静脉高压症患者胃肠激素、肝纤维化指标和血流动力学的影响[J].中西医结合肝病杂志,2009,19(2):70-72.
[19] Ghosh S,Choudhary N S,Sharma A K,et al. Noradrenaline vs terlipressin in the treatment of type 2hepatorenal syndrome:a randomizedpilot study[J].Liver Int,2013,33(8):1187-1193.
[20] Wang C,Han J,Xiao L,et al. Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of earlyvariceal rebleeding after the initial control of bleeding:a systematic review and meta-analysis[J]. Hepatol Int,2015,9(1):120-129.
[21]王琼,王景,邓菁,等.生长抑素和特利加压素单用或联用治疗肝硬化上消化道出血成本-效果分析[J].中国现代医生,2015,53(28):49-52.