奥曲肽联合特利加压素治疗肝硬化合并上消化道出血患者的临床疗效  

Clinical efficacy of octreotide combined with terlipressin in the treatment of patients with cirrhosis complicated with upper gastrointestinal bleeding

作　　者：刘凯芹 闫瑾 马许辉[3] 付媛媛 Liu Kai-qin;Yan Jin;Ma Xu-hui;Fu Yuan-yuan(Department of Infection,Weishi Central Hospital,Weishi 475500,Henan,China;Department of Gastroenterology,Weishi Central Hospital,Weishi 475500,Henan,China;Department of Gastroenterology,Huaihe Hospital of Henan University,Kaifeng 475000,Henan,China)

机构地区：[1]尉氏县中心医院感染科,河南尉氏475500 [2]尉氏县中心医院消化科,河南尉氏475500 [3]河南大学淮河医院消化科,河南开封475000

出　　处：《四川生理科学杂志》2025年第1期44-46,125,共4页

摘　　要：目的:探讨奥曲肽联合特利加压素治疗肝硬化合并上消化道出血(Upper gastrointestinal bleeding,UGIB)患者临床疗效。方法:选取我院2021年1月至2023年12月收治的80例肝硬化合并UGIB患者,根据治疗方案不同分为奥曲肽组和联合组,各40例。奥曲肽组予以奥曲肽(首次静脉推注0.1 mg,之后静脉泵注0.025 mg·h^(-1))治疗,联合组予以奥曲肽(给药剂量和方法同上)联合特利加压素(首次静脉注射2 mg,之后每间隔6 h静脉注射1 mg)治疗。治疗3 d后,比较两组总有效率、出血控制情况;治疗前及治疗3 d后,采用彩色多普勒超声检测门、脾静脉血流情况,采用电泳法检测纤维蛋白原(Fibrinogen,FIB)水平,采用胶乳凝集法检测D-二聚体(D-dimer,D-D)水平;比较两组不良反应及治疗72 h再出血情况。结果:联合组总有效率高于奥曲肽组,持续出血与血压稳定时间短于奥曲肽组,持续出血量少于奥曲肽组(P<0.05);联合组治疗24 h止血成功率高于奥曲肽组(P<0.05);治疗3 d后,联合组门、脾静脉内径均小于奥曲肽组,血流量低于奥曲肽组(P<0.05);联合组D-D水平低于奥曲肽组,FIB水平高于奥曲肽组(P<0.05);治疗后72 h,联合组再出血率低于奥曲肽组(P<0.05)。结论:奥曲肽联合特利加压素可降低肝硬化合并UGIB患者门脾静脉压力,减少血流量,改善凝血功能,从而减轻出血症状,提高止血效果,改善患者预后。Objective:To explore the clinical efficacy of octreotide combined with terlipressin in the treatment of patients with cirrhosis and upper gastrointestinal bleeding(UGIB).Methods:A total of 80 patients with cirrhosis and UGIB admitted to our hospital from January 2021 to December 2023 were divided into an octreotide group and a combined group according to different treatment regimens,with 40 patients in each group.The octreotide group was treated with octreotide(0.1 mg intravenous injection at first,followed by 0.025 mg·h^(-1)intravenous infusion),while the combined group was treated with octreotide(the same dosage and method as above)combined with terlipressin(2 mg intravenous injection at first,followed by 1 mg every 6 hours).After 3 days of treatment,the total effective rate and bleeding control were compared between the two groups.Before and after treatment,color Doppler ultrasound was used to detect the blood flow of the portal and splenic veins,electrophoresis was used to detect the level of fibrinogen(FIB),and latex agglutination was used to detect the level of D-dimer(D-D).The adverse reactions and rebleeding rate after 72 hours of treatment were compared between the two groups.Results:The total effective rate of the combined group was higher than that of the octreotide group,and the duration of bleeding and blood pressure stability were shorter than those of the octreotide group,while the amount of continuous bleeding was less than that of the octreotide group(P<0.05).The success rate of hemostasis in the combined group was higher than that of the octreotide group after 24 hours of treatment(P<0.05).After 3 days of treatment,the internal diameters of the portal and splenic veins in the combined group were smaller than those in the octreotide group,and the blood flow was lower than that of the octreotide group(P<0.05).The level of D-D in the combined group was lower than that of the octreotide group,while the level of FIB was higher than that of the octreotide group(P<0.05).After 72 hours of treatment,the

关 键 词：肝硬化 上消化道出血 奥曲肽 特利加压素 凝血功能 

分 类 号：R575.2[医药卫生—消化系统] R573.2[医药卫生—内科学]