聚桂醇和蛇毒血凝酶注射配合内镜下套扎治疗乙型肝炎肝硬化并发EVB患者疗效研究  

Endoscopic variceal ligation with lauromacrogol and snake venom hemocoagulase injection in treating patients with hepatitis B liver cirrhosis complicated by esophagogastric variceal bleeding

作　　者：李瑞妮 王莎莎 贾泽博 韦晓洁 王腾 Ruini;Wang Shasha;Jia Zebo(Department of Endoscopy,Central Hospital,Xianyang 712000,Shaanxi Province,China)

机构地区：[1]陕西省咸阳市中心医院腔镜检查治疗科,712000 [2]陕西省咸阳市中心医院消化内科,712000 [3]西安交通大学第二附属医院全科医学科 [4]延安大学咸阳医院消化内科二病区

出　　处：《实用肝脏病杂志》2024年第5期741-744,共4页Journal of Practical Hepatology

基　　金：咸阳市科学技术局科研项目(编号:2021ZDYF-SF-0049)。

摘　　要：目的探讨聚桂醇和蛇毒血凝酶注射配合内镜下套扎(EVL)治疗乙型肝炎肝硬化(LC)并发食管胃底静脉曲张破裂出血(EVB)患者的临床效果。方法2021年1月~2023年1月我院收治的98例乙型肝炎肝硬化并发EVB患者被分成对照组49例和观察组49例,分别采取EVL治疗或聚桂醇和蛇毒血凝酶注射联合EVL治疗,随访6个月。使用超声检测门静脉压(PVP)、门静脉内径(PVD)、门静脉血流速度(PVV)和门静脉血流量(PVF),采用ELISA法检测血清胃泌素(GAS)、胰高血糖素(GLC)和胃动素(MTL)水平。结果急性期观察组和对照组病死率分别为16.3%和18.4%(P>0.05),观察组止血显效率为65.3%,显著高于对照组的53.1%(P<0.05);治疗后,观察组PVP、PVV和PVF分别为(21.4±2.7)mmHg、(17.9±2.4)cm/s和(552.1±138.4)mL/min,均显著低于对照组【(24.5±2.8)mmHg、(21.9±2.2)cm/s和(735.2±159.7)mL/min,P<0.05】;观察组血清GLC和MTL水平分别为(45.6±7.6)ng/L和(214.6±19.7)ng/L,均显著低于对照组【分别为(56.3±8.4)ng/L和(248.2±22.3)ng/L,P<0.05】;观察组胸骨后疼痛发生率为24.4%,显著高于对照组的2.5%,而再出血发生率为4.9%,显著低于对照组的25.0%(P<0.05)。结论采用聚桂醇和蛇毒血凝酶注射联合EVL治疗LC并发EVB患者可显著提高止血效果,降低再出血发生率,值得进一步研究。Objective The aim of this study was to investigate the clinical efficacy of endoscopic variceal ligation(EVL)with lauromacrogol and snake venom hemocoagulase injection in treating patients with hepatitis B liver cirrhosis(LC)complicated by esophagogastric variceal bleeding(EVB).Methods 98 patients with LC and EVB were enrolled in our hospital between January 2021 and January 2023,and we assigned them to underwent EVL in control,or to underwent EVL with lauromacrogol and snake venom hemocoagulase injection in observation group.All patients were followed-up for 6 months.Portal vein pressure(PVP),portal vein diameter(PVD),portal vein velocity(PVV)and portal vein flow(PVF)were measured by color Doppler ultrasonography.Serum gastrin(GAS),glucagon(GLC)and motilin(MTL)levels were detected by ELISA.Results The 7-day mortality were 16.3%and 18.4%(P>0.05)in the observation and control group,and successful hemostasis in the observation was 65.3%,much higher than 53.1%(P<0.05)in the control;after treatment,PVP,PVV and PVF in the observation were(21.4±2.7)mmHg,(17.9±2.4)cm/s and(552.1±138.4)mL/min,all significantly lower than[(24.5±2.8)mmHg,(21.9±2.2)cm/s and(735.2±159.7)mL/min,respectively,P<0.05]in the control;serum GLC and MTL levels were(45.6±7.6)ng/L and(214.6±19.7)ng/L,both significantly lower than[(56.3±8.4)ng/L and(248.2±22.3)ng/L,respectively,P<0.05]in the control group;incidence of adverse effect,such as retrosternal pain in the observation was 24.4%,much higher than 2.5%,while rebleeding was 4.9%,much lower than 25.0%(P<0.05)in the control group.Conclusion The efficacy of EVL with Lauromacrogol and snake venom hemocoagulase injection in the treatment of LC with EVB is promising,with low rebleeding rate,and warrants further investigation.

关 键 词：肝硬化 食管胃底静脉曲张破裂出血 内镜下套扎 聚桂醇 蛇毒血凝酶 治疗 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]