去甲肾上腺素、血凝酶联合质子泵抑制剂治疗对肝硬化合并上消化道出血患者血液流变学及外周血NO、ET的影响  

Effect of norepinephrine and hemagglutinin combined with proton pump inhibitor on hemorheology and peripheral blood NO and ET in patients with cirrhosis complicated with upper gastrointestinal bleeding

作　　者：孟庆志[1] 张月华 王海舰 郑艳龙 李建霞[1] MENG Qingzhi;ZHANG Yuehua;WANG Haijian;ZHENG Yanlong;LI Jianxia(Department of Emergency,Langfang People’s Hospital,Langfang,065000,China;Department of Oncology, Langfang People’s Hospital;Department of Imaging, Langfang People’s Hospital)

机构地区：[1]廊坊市人民医院急诊科,河北廊坊065000 [2]廊坊市人民医院肿瘤科 [3]廊坊市人民医院影像科

出　　处：《中国中西医结合消化杂志》2022年第2期122-127,共6页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：河北省廊坊市科技支撑计划项目(No:2020013073)。

摘　　要：目的:探讨去甲肾上腺素、血凝酶联合质子泵抑制剂(PPI)治疗对肝硬化合并上消化道出血(UGIB)患者血液流变学及外周血NO、内皮素(ET)的影响。方法:选取2018年1月—2019年1月接受治疗的肝硬化合并UGIB的96例患者为研究对象,随机分为对照组和观察组,每组48例。对照组给予去甲肾上腺素和泮托拉唑治疗,观察组在此基础上给予血凝酶治疗。分别于治疗前后测定血液流变学及血清NO、ET、AT-Ⅱ和血红蛋白含量,测定血清氧化应激反应因子(MDA、ox-LDL、AOPP)和抗氧化酶(SOD、GSH-Px、CAT)含量;记录2组患者的输血量、止血时间、住院时间以及24 h内的止血率和止血后3 d的出血率;观察2组患者治疗前后的UGIB危急程度与治疗效果,并记录不良反应发生情况。结果:2组患者治疗前血清相关检测指标的含量比较,差异无统计学意义(P>0.05)。治疗3 d后,2组患者AT-Ⅱ、ET、MDA、ox-LDL和AOPP含量均明显降低(P<0.05),NO、SOD、GSH-Px和CAT含量明显升高(P<0.05),观察组的含量变化比对照组更显著(P<0.05),并且观察组的血液流变学显著高于对照组(P<0.05)。对照组血红蛋白含量较治疗前显著降低(P<0.05),而观察组无显著变化(P>0.05)。观察组患者输血量、止血时间、再出血率、住院时间和UGIB危急程度均明显低于对照组(P<0.05),且观察组患者有更高的止血率和治疗有效率(P<0.05)。2组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:去甲肾上腺素、血凝酶联合PPI治疗能显著改善肝硬化合并UGIB患者的出血症状和氧化应激反应,提高外周血NO含量、降低ET含量,改善患者血液流变学,缩短住院时间,有较好的治疗效果,安全性可靠,值得临床推广。Objective:To explore the effect of norepinephrine,hemagglutinin combined with proton pump inhibitor(PPI) on hemorheology and peripheral blood NO and ET in patients with cirrhosis complicated with upper gastrointestinal bleeding(UGIB).Methods:A total of 96 patients with cirrhosis complicated with UGIB who received treatment in our hospital from January 2018 to January 2019 were selected as the research objects and randomly divided into control group and observation group,with 48 cases in each group.Patients in the control group were treated with norepinephrine and pantoprazole,and patients in the observation group were treated with hemagglutinin on the basis of the control group.The hemorheology,the contents of NO,ET,AT-Ⅱand hemoglobin in serum,the contents of oxidative stress factors(MDA,ox-LDL,AOPP) and antioxidant enzymes(SOD,GSH-Px,CAT) in serum were measured before and after treatment,respectively.The blood transfusion volume,hemostatic time,hospital stay,hemostatic rate within 24 h and the bleeding rate in 3 days after hemostasis were recorded in 2 groups.The severity of UGIB and treatment effect before and after treatment were observed in 2 groups,and the incidence of adverse events was recorded.Results:There was no significant difference in the contents of serum related indicators between 2 groups before treatment(P>0.05).After 3 d treatment,the contents of AT-Ⅱ,ET,MDA,ox-LDL and AOPP in 2 groups were significantly decreased(P<0.05),while the contents of NO,SOD,GSH-Px and CAT were significantly increased(P<0.05).The content changes in the observation group were more significant than those in the control group(P<0.05),and the hemorheology in the observation group was significantly higher than that in the control group(P<0.05).The hemoglobin content in the control group was significantly decreased compared with that before treatment(P<0.05),but there was no significant change in the observation group(P>0.05).The amount of blood transfusion,hemostatic time,rebleeding rate,hospital stay and the critical de

关 键 词：肝硬化 上消化道出血 去甲肾上腺素 血凝酶 质子泵抑制剂 

分 类 号：R575.2[医药卫生—消化系统]