内镜下组织胶注射联合套扎术、奥曲肽对EGVB凝血功能和再出血的影响  

Effects of endoscopic tissue gel injection combined with ligation and octreotide on the coagulation function and rebleeding in the treatment of EGVB

作　　者：李依柯 邓肖霞 苏建伟[1] LI Yike;DENG Xiaoxia;SU Jianwei(Department of Gastroenterology,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China;Graduate School,Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China)

机构地区：[1]右江民族医学院附属医院消化内科,广西百色533000 [2]右江民族医学院研究生学院,广西百色533000

出　　处：《右江医学》2024年第8期680-685,共6页Chinese Youjiang Medical Journal

基　　金：国家自然科学基金(81760739);2017年度高校中青年教师基础能力提升项目(2017KY0519);右江民族医学院2016年度重点实验室开放课题(kfkt2016010);2016年广西研究生创新计划项目(201601007);2017年度广西医药卫生自筹经费计划课题(Z20170242)。

摘　　要：目的探讨内镜下组织胶注射与套扎术结合奥曲肽治疗食管胃底静脉曲张破裂出血(EGVB)对凝血功能及再出血率的影响。方法选取2020年1月至2023年1月符合纳入和排除标准的226例EGVB患者作为研究对象,根据随机数字表将患者分为研究组和对照组,每组113例。对照组患者接受套扎术联合奥曲肽治疗,而研究组患者则接受内镜下组织胶注射联合套扎术及奥曲肽治疗。比较两组的治疗效果、输血量、止血时间、呕血改善时间、凝血功能指标[活化部分凝血酶原时间(APTT)、凝血酶原时间(PT)、凝血时间(TT)]、门静脉血流动力学参数[门静脉压(PVP)、门静脉血流量(PVF)、门静脉血流速度(PVV)]、胃肠激素水平[胃泌素-17(GAS-17)、胃蛋白酶原Ⅰ(PG-Ⅰ)、胃蛋白酶原Ⅱ(PG-Ⅱ)]以及再出血率。结果研究组的总有效率为97.35%(110/113),显著高于对照组的90.27%(102/113),差异有统计学意义(P<0.05)。与对照组相比,研究组的输血量较少,止血时间和呕血改善时间较短,差异均有统计学意义(P<0.001)。治疗后,两组患者的APTT、PT、TT均较治疗前有所缩短,且研究组的缩短程度大于对照组,差异有统计学意义(P<0.001)。同样,治疗后两组患者的PVP、PVF、PVV均较治疗前有所降低,研究组的降低程度亦大于对照组,差异有统计学意义(P<0.001)。治疗后,两组患者的GAS-17、PG-Ⅰ、PG-Ⅱ水平均较治疗前有所下降,研究组的下降程度亦大于对照组,差异有统计学意义(P<0.001)。在治疗后1个月和3个月,研究组的再出血率分别为0和5.31%(6/113),均低于对照组的7.96%(9/113)和13.27%(15/113),差异有统计学意义(P<0.05或0.01)。结论内镜下组织胶注射联合套扎术及奥曲肽治疗EGVB具有确切的疗效,能够改善凝血功能和出血症状,优化门静脉血流动力学,降低再出血率,并减轻胃肠功能损伤。Objective To explore the effects of endoscopic tissue gel injection and ligation combined with octreotide on coagulation function and rebleeding rate in the treatment of esophageal-gastric variceal bleeding(EGVB).Methods A total of 226 EGVB patients who met inclusion and exclusion criteria from January 2020 to January 2023 were selected as study subjects.They were divided into study group and control group according to random number table,with 113 patients in each group.The control group were treated with ligation combined with octreotide,while the study group were treated with endoscopic tissue gel injection combined with ligation and octreotide.And then,therapeutic effects,blood transfusion volume,hemostatic time,hematemesis improvement time,coagulation functions(activated partial prothrombin time[APTT],prothrombin time[PT],coagulation time[TT]),portal vein hemodynamics(portal vein pressure[PVP],portal vein blood flow[PVF],portal vein blood flow velocity[PVV]),gastrointestinal hormone levels(gastrin-17[Gas-17],pepsin I[PG-Ⅰ],pepsinⅡ[PG-Ⅱ]),and rebleeding rates were compared between the two groups.Results The total effective rate of the study group(97.35%,110/113)was significantly higher than that of the control group(90.27%,102/113),and difference was statistically significant(P<0.05).Compared with the control group,the study group had less blood transfusion,hematemesis time,and hematemesis improvement time,and difference was statistically significant(P<0.001).After treatment,APTT,PT,and TT were shortened in both groups compared with those before treatment,and those in the study group were shorter than those in the control group,and difference was statistically significant(P<0.001).After treatment,PVP,PVF,and PVV in both groups decreased,and those in the study group decreased more significantly than those in the control group,and difference was statistically significant(P<0.001).After treatment,Gas-17,PG-Ⅰ,and PG-Ⅱin the two groups decreased,and those in the study group also decreased more significant

关 键 词：食管胃底静脉曲张破裂出血 内镜下组织胶注射 套扎术 奥曲肽 

分 类 号：R573.2[医药卫生—消化系统]