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  

Therapeutic Effect of Different Doses of Somatostatin in the Treatment of Liver Cirrhosis with Esophageal and Gastric Variceal Bleeding

作　　者：易省阳[1] 邹姣玲 王翔[1] 谢会忠[2] YI Sheng - yang ZOU Jiao - ling WANG Xiang XIE Hui - zhong(Department of Longhua Emergency, Hainan General Hospital, Haikou 570102, China Department of Gastroenterology, the Second Affiliated Hospital of Hainan Medical University, Haikou 570311, China)

机构地区：[1]海南省人民医院龙华急诊科,海南省海口市570102 [2]海南医学院第二附属医院消化内科,海南省海口市570311

出　　处：《中国全科医学》2017年第19期2363-2368,共6页Chinese General Practice

基　　金：海南省卫生厅科研课题(琼卫2012 PT-04)

摘　　要：目的探讨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。方法选取2013—2015年入住海南省人民医院急诊ICU及消化内科的符合纳入标准的102例肝硬化合并食管胃底静脉曲张破裂出血患者,根据随机数字表法将患者分为标准剂量组(A组)和加倍剂量组(B组),各51例。依据患者就诊时既往出血次数(是否<2次)对A、B两组依次再分为A1组(既往出血<2次)、A2组(既往出血≥2次),B1组(既往出血<2次)、B2组(既往出血≥2次)。A组给予生长抑素首剂4.1 ml静脉注射后,再给予生长抑素4.1 ml/h持续泵入,持续5 d。B组给予生长抑素首剂8.2 ml静脉注射后,再给予生长抑素8.2 ml/h持续泵入,持续5 d。比较A组和B组、A1组和B1组、A2组和B2组的首次止血成功率、再出血率、治疗有效率、病死率。结果 B组的首次止血成功率、治疗有效率高于A组,再出血率低于A组(P<0.05)。B2组的首次止血成功率高于A2组,再出血率低于A2组(P<0.05)。结论对于肝硬化合并食管胃底静脉曲张破裂出血患者,加倍剂量生长抑素治疗是有效的,尤其是对于既往出血≥2次的患者,可以明显降低再出血率。Objective To explore the clinical efficacy about different doses of somatostatin in the treatment of esophageal and gastric variceal bleeding in liver cirrhosis.Methods We carried out a randomized controlled clinical trial in 102 liver cirrhosis patients with esophageal and gastric variceal bleeding who hospitalized in the Emergency ICU and Department of Gastroenterology,Hainan General Hospital between 2013 and 2015 and met the inclusion criteria.They were randomized into standard-dose treatment group（group A） and double standard-dose treatment group（group B） with 51 cases in each.Based on the number of previous bleedings,group A and group B were further divided into subgroup A1（previous bleedings 2 times）and subgroup A2（previous bleedings ≥ 2 times）,subgroup B1（previous bleedings 2 times）,and subgroup B2（previous bleedings ≥ 2 times）,respectively.The first intravenous injection dose of somatostatin was 4.1 ml,8.2 ml for group A and group B,respectively.After that,patients in group A and group B were given continuous intravenous infusion of somatostatin 4.1ml/h,8.2 ml/h with a pump for 5 days,respectively.The success rate of first hemostasis,rebleeding rate,response rate and mortality rate were compared between group A and group B,group A1 and group B1,group A2 and group B2.Results Compared with group A,group B had higher success rate of first hemostasis（P〈0.05）,higher response rate（P〈0.05）,and lower rebleeding rate（P〈0.05）.The success rate of the first hemostasis in group B2 was higher than that in group A2（P〈0.05）,and the rebleeding rate was lower than that in group A2（P〈0.05）.Conclusion Double standard-dose somatostatin treatment is effective in liver cirrhosis patients with esophageal and gastric variceal bleeding,especially in those with previous bleeding ≥ 2 times,the rebleeding rate can be significantly reduced.

关 键 词：肝硬化 食管和胃静脉曲张 生长抑素 治疗结果 

分 类 号：R575.2[医药卫生—消化系统]