高剂量生长抑素对内镜套扎术食管静脉曲张破裂出血患者的疗效观察
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摘要
目的观察高剂量生长抑素(SS)对行内镜下食管静脉曲张套扎术食管静脉曲张破裂出血(EVB)患者的疗效。方法我院收治的371例EVB患者,按随机数字表法分为观察组(n=180)与对照组(n=191),两组入院后均积极恢复血容量,并给予SS降低门静脉压等综合性治疗,对照组SS剂量为250μg/h,观察组为500μg/h,均24 h微泵持续静脉滴注,并在完善术前准备后开展食管曲张静脉内镜套扎术(EVL)治疗。对比两组疗效。结果两组病死率、不良反应发生率比较差异无统计学意义(P> 0. 05);观察组止血时间、平均输血量、平均住院时间均短于对照组,24 h止血率高于对照组,再出血发生率低于对照组(P <0. 05)。结论对EVB患者,高剂量SS不仅可取得更佳的止血获益,且不增加药物不良反应风险。
Objective To observe the curative effect of high-dose somatostatin( SS) in the treatment of esophageal variceal bleeding( EVB) patients by using endoscopic ligation.Methods A total of 371 patients with EVB admitted to our hospital were divided into observation group( n = 180) and control group( n = 191) by the random number table method.The blood volumes of the patients were actively recovered after admission and both groups were given SS to reduce the portal pressure and other comprehensive treatments.The doses of SS for the control group and the observation group were 250 μg/h and 500 μg/h,respectively.The SS were infused intravenously through micro pump in 24 h. Esophageal variceal ligation( EVL) was performed after completing preoperative preparation. The curative effect was compared between the two groups.Results There was no significant difference in mortality and incidence of adverse reactions between the two groups( P > 0. 05).The hemostasis time,mean blood transfusion volume and average hospital stay of the observation group were shorter/smaller than those of the control group.The 24 h hemostasis rate was higher and the incidence of re-bleeding was lower in the observation group than those of the control group( P < 0. 05).Conclusion For patients with EVB treated with endoscopic ligation,high-dose SS not only achieve better hemostatic effect,but also do not increase the risk of adverse drug reactions.
Objective To observe the curative effect of high-dose somatostatin( SS) in the treatment of esophageal variceal bleeding( EVB) patients by using endoscopic ligation.Methods A total of 371 patients with EVB admitted to our hospital were divided into observation group( n = 180) and control group( n = 191) by the random number table method.The blood volumes of the patients were actively recovered after admission and both groups were given SS to reduce the portal pressure and other comprehensive treatments.The doses of SS for the control group and the observation group were 250 μg/h and 500 μg/h,respectively.The SS were infused intravenously through micro pump in 24 h. Esophageal variceal ligation( EVL) was performed after completing preoperative preparation. The curative effect was compared between the two groups.Results There was no significant difference in mortality and incidence of adverse reactions between the two groups( P > 0. 05).The hemostasis time,mean blood transfusion volume and average hospital stay of the observation group were shorter/smaller than those of the control group.The 24 h hemostasis rate was higher and the incidence of re-bleeding was lower in the observation group than those of the control group( P < 0. 05).Conclusion For patients with EVB treated with endoscopic ligation,high-dose SS not only achieve better hemostatic effect,but also do not increase the risk of adverse drug reactions.
引文
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[6]雷利群,罗宏丽,肖顺林.临床药师对1例乙肝后肝硬化腹水合并食管胃静脉曲张破裂出血患者的药学监护[J].中国药房,2014,25(34):3259-3261.
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[8]内镜下食管静脉曲张套扎术分别联用生长抑素或特利加压素或奥曲肽治疗食管胃底静脉曲张破裂出血住院成本-效果分析[J].中国全科医学,2018,20(15):2363-2368.
[9]龚金红,杜沈蓥荧,刘广军,等.血管活性药物治疗肝硬化致食管胃底静脉曲张破裂出血的循证药物经济学评价[J].中国药房,2017,28(2):152-157.
[10]易省阳,邹姣玲,王翔,等.不同剂量生长抑素治疗肝硬化合并食管胃底静脉曲张破裂出血的临床效果研究[J].中国全科医学,2017,20(19):2363-2368.
[11]唐海平,张文龙,罗仪,等.肝硬化患者输血现状的调查[J].中国输血杂志,2017,30(12):1382-1384.
[12]王国栋,张腾,李杰,等.输血导致莱姆病形成Ⅲ度房室传导阻滞一例[J].中华传染病杂志,2017,35(4):243.
[13]Wang C,Han J,Xiao L,et al.Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding:a systematic review and meta-analysis[J].Hepatology International,2015,9(1):120-129.
[14]Seo YS,Park SY,Kim MY,et al.Lack of difference among terlipressin,somatostatin,and octreotide in the control of acute gastroesophageal variceal hemorrhage[J].Hepatology,2015,60(3):954-963.
[2]Bintintan A,Chira RI,Bintintan VV,et al.Value of hepatic elastography and Doppler indexes for predictions of esophageal varices in liver cirrhosis[J].Medical Ultrasonography,2015,17(1):5-11.
[3]Hung TH,Tsai CC,Tseng CW,et al.No difference in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding and renal functional impairment[J]. European Journal of Gastroenterology Hepatology,2016,28(11):1275-1279.
[4]Alempijevic T,Balovic A,Markovic AP,et al.Efficacy of long-acting somatostatin analogs in recurrent variceal bleeding in a patient with prehepatic portal vein thrombosis[J]. Vojnosanitetski Pregled,2015,72(3):283-286.
[5]Hung TH,Tsai CC,Tseng CW,et al. No difference in mortality between terlipressin and somatostatin treatments in cirrhotic patients with esophageal variceal bleeding and renal functional impairment[J]. European Journal of Gastroenterology&Hepatology,2016,28(11):1275-1279.
[6]雷利群,罗宏丽,肖顺林.临床药师对1例乙肝后肝硬化腹水合并食管胃静脉曲张破裂出血患者的药学监护[J].中国药房,2014,25(34):3259-3261.
[7]中华医学会肝病学分会.肝硬化门静脉高压食管胃静脉曲张出血防治指南(2015)[J].中华胃肠内镜电子杂志,2015,2(4):1-21.
[8]内镜下食管静脉曲张套扎术分别联用生长抑素或特利加压素或奥曲肽治疗食管胃底静脉曲张破裂出血住院成本-效果分析[J].中国全科医学,2018,20(15):2363-2368.
[9]龚金红,杜沈蓥荧,刘广军,等.血管活性药物治疗肝硬化致食管胃底静脉曲张破裂出血的循证药物经济学评价[J].中国药房,2017,28(2):152-157.
[10]易省阳,邹姣玲,王翔,等.不同剂量生长抑素治疗肝硬化合并食管胃底静脉曲张破裂出血的临床效果研究[J].中国全科医学,2017,20(19):2363-2368.
[11]唐海平,张文龙,罗仪,等.肝硬化患者输血现状的调查[J].中国输血杂志,2017,30(12):1382-1384.
[12]王国栋,张腾,李杰,等.输血导致莱姆病形成Ⅲ度房室传导阻滞一例[J].中华传染病杂志,2017,35(4):243.
[13]Wang C,Han J,Xiao L,et al.Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding:a systematic review and meta-analysis[J].Hepatology International,2015,9(1):120-129.
[14]Seo YS,Park SY,Kim MY,et al.Lack of difference among terlipressin,somatostatin,and octreotide in the control of acute gastroesophageal variceal hemorrhage[J].Hepatology,2015,60(3):954-963.