内镜下套扎联合奥曲肽和埃索美拉唑治疗肝硬化并发食管静脉曲张破裂出血患者临床疗效研究  

Clinical efficacy of endoscopic variceal ligation and intravinous octreotide and esomeprazole infusion in the treatment of patients with liver cirrhosis and esophagogastric variceal bleeding

作　　者：马莉 顾中盛 李想 Ma Li;Gu Zhongsheng;Li Xiang(Department of Pharmacy,Provincial People's Hospital,Affiliated to Nanjing Medical University,Nanjing 210029,Jiangsu Province,China)

机构地区：[1]南京医科大学第一附属医院/江苏省人民医院药学部,南京市210029

出　　处：《实用肝脏病杂志》2024年第6期903-906,共4页Journal of Practical Hepatology

基　　金：江苏省中医药科技发展计划项目(编号:YB2020096)。

摘　　要：目的探讨内镜下套扎术(EVL)联合奥曲肽和埃索美拉唑治疗肝硬化(LC)并发食管静脉曲张破裂出血(EVB)患者的临床效果。方法2020年12月~2022年12月我院诊治的99例LC并发EVB患者,被随机分为对照组50例和观察组49例,均接受EVL和静脉注射埃索美拉唑治疗,观察组另给奥曲肽静脉泵入,治疗1 w,随访1年。使用微量试剂盒检测血清一氧化氮(NO);采用ELISA法检测血清内皮素(ET)和血管紧张素Ⅱ(ATⅡ)水平;使用超声检测门静脉内径(PVD)、门静脉血流量(PVF)、脾静脉内径(SVD)和脾静脉血流量(SVF)。结果在急性期,观察组和对照组各死亡2例;在47例观察组和48例对照组生存者中,观察组24 h、48 h和72 h止血率分别为66.0%、95.7%和100.0%,与对照组的62.5%、85.4%和100.0%比,无显著性差异(P>0.05);治疗后,观察组PVD、PVF和SVF分别为(10.5±1.6)mm、(252.4±42.6)mL/min和(526.3±68.9)mL/min,均显著低于对照组【分别为(12.1±1.4)mm、(304.5±41.6)mL/min和(611.4±64.5)mL/min,P<0.05】;观察组血清NO水平为(73.2±7.6)mol/L,显著高于对照组【(64.9±7.4)mol/L,P<0.05】,而血清ET和ATⅡ水平分别为(90.2±9.3)ng/L和(3.0±0.5)pg/mL,均显著低于对照组【分别为(104.8±11.4)ng/L和(4.1±0.6)pg/mL,P<0.05】;术后随访1年,观察组和对照组再出血发生率分别为10.6%和12.5%(P>0.05)。结论采用EVL联合奥曲肽和埃索美拉唑治疗LC并发EVB患者可以获得止血疗效,改善门脉血流动力学和血清血管活性指标,值得临床进一步观察。Objective The aim of this study was to investigate clinical efficacy of endoscopic variceal ligation(EVL)and intravinous octreotide and esomeprazole infusion in the treatment of patients with liver cirrhosis(LC)and esophagogastric variceal bleeding(EVB).Methods 99 patients with LC and EVB were admitted to our hospital between December 2020 and December 2022,and were randomly divided into observation(n=49)and control group(n=50).All patients received EVL and intrvinous esomeprazole infusion,and those in the observation were additionally given intravenous octreotide bumping for 7 days.Serum nitric oxide(NO),endothelin(ET)and angiotensinⅡ(ATⅡ)levels were assayed.Portal vein diameter(PVD),portal vein flow(PVF),splenic vein diameter(SVD)and splenic vein flow(SVF)were detected by ultrasonography.Results Two and two patients didn’t survive emergent bleeding in both groups;of survivals,hemostasis rates at 24 h,48 h and 72 h in the observation group were 66.0%,95.7%and 100.0%,not significantly different compared to 62.5%,85.4%and 100.0%(P>0.05)in the control;after treatment,PVD,PVF and SVF in the observation were(10.5±1.6)mm,(252.4±42.6)mL/min and(526.3±68.9)mL/min,all significantly lower than[(12.1±1.4)mm,(304.5±41.6)mL/minand(611.4±64.5)mL/min,respectively,P<0.05]in the control;serum NO level in the observation was(73.2±7.6)mol/L,much higher than[(64.9±7.4)mol/L,P<0.05],while serum ET and ATⅡlevels were(90.2±9.3)ng/L and(3.0±0.5)pg/mL,much lower than[(104.8±11.4)ng/L and(4.1±0.6)pg/mL,P<0.05]in the control group;one year of follow-up after treatment,re-bleeding rates in the observation and control groups were not much statistically significantly different(10.6%vs.12.5%,P>0.05).Conclusion EVL and octreotide and esomeprazole combination in dealing urgently with patients with EVB has a satisfactory hemostasis efficacy,which might improve liver hemodynamicsand serum vascular activity.

关 键 词：肝硬化 食管静脉曲张破裂出血 内镜下套扎 奥曲肽 埃索美拉唑 治疗 再出血 

分 类 号：R575.2[医药卫生—消化系统]