高剂量生长抑素对急诊肝硬化合并食管胃底静脉曲张破裂出血的疗效增益价值
| 作者: |
1夏于新,
2罗雄,
1牛红霞,
1褚晓雯,
1陈士轩
1 北京电力医院急诊科，北京 100073 2 北京核工业医院内科，北京 100045 |
| 通讯: |
夏于新
Email: pleased2013@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.11.017 |
| 基金: | 北京市科技计划项目(20140234)。 |
摘要
目的：探讨高剂量生长抑素对急诊肝硬化合并食管胃底静脉曲张破裂出血(esophageal-gastric varices bleeding，EGVB)的效果。方法：共纳入2015年6月至2018年6月期间在北京电力医院急诊及消化内科诊治的94例肝硬化合并EGVB患者，随机数表法分为对照组与观察组，两组各47例。对照组缓慢静脉注射250 μg生长抑素后持续泵注250 μg/h，观察组缓慢静脉注射500 μg生长抑素后持续泵注500 μg/h，均持续治疗5 d。两组治疗期间均留置胃管积极评估出血情况，给予密切监护、液体复苏、内镜检查、敏感抗生素抗感染等处理。比较两组止血效果、再出血发生率、不良反应以及死亡情况。结果：观察组首次止血成功率(87.23%)、止血有效率(82.98%)均高于对照组(68.09%，63.83%)，再出血率(14.89%)低于对照组(34.04%)，差异均有统计学意义(χ2=4.065，4.414，4.663；P<0.05)，两组病死率、不良反应率比较(10.64% vs 17.02%，23.40% vs 14.89%)，差异均无统计学意义(χ2=0.803、1.099，P>0.05)；两组既往出血<2次患者首次止血成功率、再出血率比较(90.00% vs 86.21%，10.00% vs 17.24%)，差异均无统计学意义(χ2=0.203，0.660，P>0.05)，观察组既往出血≥2次患者首次止血成功率(82.35%)高于对照组(38.89%)，再出血率(23.53%)低于对照组(61.11%)，差异均有统计学意义(χ2=6.882，5.042，P<0.05)。结论：在肝硬化合并EGVB患者的急诊救治中，早期给予高剂量生长抑素能增益止血疗效且不增加不良反应，尤其对降低既往出血≥2次者再出血风险效果显著，对改善预后生存具有重要意义。
关键词：
肝硬化；食管胃底静脉曲张破裂出血；生长抑素；高剂量；止血效果；不良反应
Therapeutic value of high-dose somatostatin in the treatment of acute cirrhosis complicated with esophageal and gastric varices bleeding
CorrespondingAuthor: XIA Yuxin Email: pleased2013@163.com
DOI: 10.3978/j.issn.2095-6959.2019.11.017
Foundation: This work was supported by Beijing Science and Technology Plan Project, China (20140234).
Abstract
Objective: To investigate the effect of high dose somatostatin on emergency cirrhosis complicated with esophageal-gastric varices bleeding (EGVB). Methods: A total of 94 patients with liver cirrhosis complicated with EGVB were enrolled from June 2015 to June 2018 in Emergency and Department of gastroenterology. They were randomly divided into a control group and an observation group with 47 cases in each group. The control group continued to pump 250 μg/h after slow intravenous injection of 250 μg somatostatin, while the observation group continued to pump 500 μg/h after slow intravenous injection of 500 μg somatostatin, all of which lasted for 5 days. During the treatment period, both groups were positively assessed for bleeding by indwelling gastric tube, and were treated with close monitoring, fluid resuscitation, endoscopy, sensitive antibiotics and anti-infection. The hemostatic effect, the incidence of rebleeding, adverse reactions and death were compared between the two groups. Results: The success rate of first hemostasis and the effective rate of hemostasis in the observation group were 87.23% and 82.98% respectively, which were higher than 68.09% and 63.83% in the control group. The rebleeding rate was 14.89% and lower than 34.04% in the control group. The difference was statistically significant (χ2=4.065, 4.414, 4.663, P<0.05). The mortality rate and adverse reaction rate of the two groups were 10.64% vs 17.02%, 23.40% vs 14.89%, and the difference was not significant (χ2=0.803, 1.099, P>0.05). The success rate of first hemostasis and rebleeding rate of patients with previous bleeding less than 2 times were compared between the two groups (90.00% vs 86.21%, 10.00% vs 17.24%). The difference was not significant (χ2=0.203, 0.660, P>0.05). The success rate of first hemostasis in the observation group was 82.35% higher than that in the control group (38.89%) and the rebleeding rate was 23.53% lower than that in the control group (61.11%). The difference was statistically significant (χ2=6.882, 5.042, P<0.05). Conclusion: In the emergency treatment of patients with liver cirrhosis and EGVB, early administration of high dose somatostatin can increase hemostatic efficacy without increasing adverse reactions, especially for reducing the risk of re-bleeding in patients with previous bleeding more than 2 times, which is of great significance for improving prognosis and survival.
Keywords：
liver cirrhosis; esophageal and gastric varices bleeding; somatostatin; high dose; hemostatic effect; adverse reactions