蛇毒血凝酶治疗急性上消化道出血患者的临床研究  

Clinical trial of snake venom hemocoagulase in the treatment of patients with acute upper gastrointestinal bleeding

作　　者：聂哲龙 张圣[1] 张延威[1] 何晨熙 刘岩 NIE Zhe-long;ZHANG Sheng;ZHANG Yan-wei;HE Chen-xi;LIU Yan(Department of Emergency,Xingtai People's Hospital,Xingtai 054000,Hebei Province,China;Department of Gastroenterology,Xingtai People's Hospital,Xingtai 054000,Hebei Province,China)

机构地区：[1]邢台市人民医院急诊科,河北邢台054000 [2]邢台市人民医院消化内科,河北邢台054000

出　　处：《中国临床药理学杂志》2025年第4期457-461,共5页The Chinese Journal of Clinical Pharmacology

基　　金：邢台市重点研发计划自筹基金资助项目(2021ZC141)。

摘　　要：目的观察蛇毒血凝酶注射液联合氨甲环酸注射液和注射用奥美拉唑钠治疗急性上消化道出血急诊患者的临床疗效及安全性。方法将急性上消化道出血患者根据队列法分为对照组和试验组。对照组患者给予氨甲环酸注射液500 mg(qd)联合注射用奥美拉唑钠40 mg(bid),静脉滴注;试验组在对照组治疗的基础上,联合给予蛇毒血凝酶注射液0.5~1.5 kU(早晚各1次)。所有患者均治疗3 d。比较2组患者的总有效率、凝血功能[血小板(PLT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、血浆凝血酶原时间(PT)]、血流动力学[血浆黏度(PV)、红细胞沉降率(ESR)、全血高切黏度(WBVH)和血细胞比容(HCT)]、炎症应激反应[C反应蛋白(CRP)、皮质醇(Cor)和中性粒细胞与淋巴细胞比值(NLR)],以及药物不良反应情况。结果本研究共入组120例患者,其中对照组58例,试验组62例。治疗后,对照组和试验组的总有效率分别为79.31%(46例/58例)和95.16%(59例/62例),在统计学上差异有统计学意义(P<0.05)。治疗后,对照组和试验组的PLT分别为(170.18±10.86)和(180.18±9.83)×10^(9)·L^(-1),APTT分别为(47.39±4.52)和(44.68±4.62)s,Fib分别为(2.98±0.33)和(3.21±0.28)g·L^(-1),PT分别为(19.21±3.76)和(17.01±2.62)s,PV分别为(1.98±0.36)和(2.38±0.43)MPa·s,ESR分别为(53.69±4.52)%和(59.89±14.62)%,WBVH分别为(7.08±0.23)和(7.98±0.28)MPa·s,HCT分别为(49.21±5.62)和(52.01±8.62)L·L^(-1),CRP分别为(8.63±1.36)和(6.38±0.93)mg·L^(-1),Cor分别为(323.69±14.82)和(315.86±14.62)mmol·L^(-1),NLP分别为4.08±0.43和2.98±0.48,试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。试验期间,对照组患者发生的药物不良反应主要有胃胀、头晕头痛和腹泻,试验组患者发生的药物不良反应主要有胃胀、头晕头痛和腹泻。对照组和试验组的药物不良反应总发生率分别为10.34%(6例/58例)和12.90%(8例/62�Objective To observe the efficacy and safety of snake venom hemocoagulase injection combined with tranexamic acid injection and omeprazole sodium injection in the treatment of emergency patients with acute upper gastrointestinal bleeding.Methods Patients with acute upper gastrointestinal bleeding were divided into control group and treatment group according to the cohort method.Patients in the control group were administered with tranexamic acid injection 500 mg(iv;qd)combined with omeprazole sodium for injection 40 mg(bid);the treatment group was given snake venom hemocoagulase injection 0.5-1.5 k U(once in the morning and once in the evening)on the basis of the control group.All patients were treated for 3 d.The total effective rate,coagulation function[platelet(PLT),activated partial thromboplastin time(APTT),fibrinogen(Fib),plasma prothrombin time(PT)],hemodynamics[plasma viscosity(PV),erythrocyte sedimentation rate(ESR),whole blood high shear viscosity(WBVH)and hematocrit(HCT)],inflammatory stress response[C-reactive protein(CRP),cortisol(Cor)and neutrophil to lymphocyte ratio(NLR)],and adverse drug reactions were compared between two groups.Results A total of 120 patients were enrolled in this trial,including 58 in the control group and 62 in the treatment group.After treatment,the effective rates of the control group and the treatment group were 79.31%(46 cases/58 cases)and 95.16%(59 cases/62 cases),respectively,with statistical difference(P<0.05).After treatment,the PLT levels in the control and treatment groups were(170.18±10.86)and(180.18±9.83)×10^(9)·L^(-1),respectively;APTT values were(47.39±4.52)and(44.68±4.62),respectively;Fib levels were(2.98±0.33)and(3.21±0.28)g·L^(-1),respectively;PT values were(19.21±3.76)and(17.01±2.62)seconds,respectively;PV levels were(1.98±0.36)and(2.38±0.43)MPa·s,respectively;ESR values were(53.69±4.52)%and(59.89±14.62)%,respectively;WBVH levels were(7.08±0.23)and(7.98±0.28)MPa·s,respectively;HCT levels were(49.21±5.62)and(52.01±8.62)L·L^(-1),respectiv

关 键 词：蛇毒血凝酶注射液 氨甲环酸注射液 注射用奥美拉唑钠 急性上消化道出血 临床疗效 

分 类 号：R973[医药卫生—药品]