内镜下套扎联合奥曲肽和凝血酶治疗肝硬化并发食管胃静脉曲张出血患者疗效研究  

Esophageal variceal ligation with auxiliary oral thrombin and intravenous octreotide administration in the treatment of cirrhotics with esophageal and gastric variceal bleeding

作　　者：田琳 康颖 崔洁[2] 石颖鹏 Tian Lin;Kang Ying;Cui Jie(Department of Gastroenterology,Central Hospital,Shangluo 726000,Shaanxi Province,China)

机构地区：[1]陕西省商洛市中心医院消化内科,726000 [2]西安医学院第一附属医院全科医学科

出　　处：《实用肝脏病杂志》2024年第5期745-748,共4页Journal of Practical Hepatology

基　　金：陕西省卫生健康委员会科研基金资助项目(编号:2022E010)。

摘　　要：目的观察应用内镜下套扎(EVL)联合凝血酶散和奥曲肽治疗肝硬化并发食管胃静脉曲张破裂出血(EGVB)患者的临床疗效。方法2021年6月~2023年6月我院收治的120例肝硬化并发EGVB患者,其中60例观察组接受EVL联合凝血酶散口服和静脉应用奥曲肽治疗,另60例对照组接受奥曲肽联合EVL治疗。药物治疗维持1 w,随访3 m。经颈静脉穿刺测量肝静脉楔压(WHVP)和肝静脉游离压(FHVP),计算肝静脉压力梯度(HVPG)。结果在治疗1 w末,观察组死亡2例,对照组死亡8例,观察组止血成功率为96.7%,显著高于对照组的86.7%(P<0.05);在生存患者中,观察组早发再出血、迟发再出血和曲张静脉(EV)消失率分别为22.4%、17.2%和69.0%,与对照组比,均无显著性差异(分别为16.7%、13.3%和73.1%,P>0.05);治疗后,观察组HVPG为(19.1±2.6)mmHg,与对照组【(19.0±3.0)mmHg】比,无显著性差异(P>0.05);治疗前后,两组血清肝肾功能指标比较,差异无统计学意义(P>0.05)。结论采用EVL联合凝血酶散口服和奥曲肽静脉应用治疗肝硬化并发EGVB患者止血效果好,可短期消除EV,防止再出血。Objective This study was conducted to investigate clinical efficacy of esophageal variceal ligation(EVL)with auxiliary oral thrombin and intravenous octreotide administration in the treatment of cirrhotics with esophageal and gastric variceal bleeding(EGVB).Method 120 patients with liver cirrhosis(LC)complicated with EGVB were admitted to our hospital between June 2021 and June 2023,and among them,60 patients in observation received EVL with auxiliary oral thrombin powder and intranenous octreotide administration,and another 60 patients in control received EVL and octreotide infusion.Medical treatment continued for 1 week,and all patients in the two groups were followed-up for three months.Wedged hepatic vein pressure(WHVP)and free hepatic vein pressure(FHVP)were measured by through jugular vein approach for calculation of hepatic vein pressure gradient(HVPG).Result At end of one week treatment,two and eight patients in the observation and control died,with successful hemostasis of 96.7%in the observation group,much higher than 86.7%(P<0.05)in the control;among survivals,early and delayed rebleeding and disappearance of varies in the observation were 22.4%,17.2%and 69.0%,all not significantly different compared to 16.7%,13.3%and 73.1%(P>0.05)in the control;after treatment,HVPG in the observation was(19.1±2.6)mmHg,not significantly different compared to(19.0±3.0)mmHg in the control(P>0.05);at admission and after treatment,there were no significant differences as respect to hepatic and renal function tests in the two groups(P>0.05).Conclusion The EVL with auxiliary treatment of oral thrombin powder and intranenous octreotide maintenance in the treatment of patients with EGVB has a good efficacy,with ascertainable hemostatic effect and prevention of rebleeding.

关 键 词：肝硬化 食管胃静脉曲张 内镜下静脉曲张套扎术 凝血酶散 奥曲肽 治疗 

分 类 号：R575.2[医药卫生—消化系统]