不同剂量生长抑素治疗肝硬化合并食管胃底静脉曲张破裂出血的临床效果研究

摘要

目的 探讨不同剂量生长抑素治疗肝硬化合并食管胃底静脉曲张破裂出血的临床效果.方法 选取2013-2015年入住海南省人民医院急诊ICU及消化内科的符合纳入标准的102例肝硬化合并食管胃底静脉曲张破裂出血患者,根据随机数字表法将患者分为标准剂量组(A组)和加倍剂量组(B组),各51例.依据患者就诊时既往出血次数(是否<2次)对A、B两组依次再分为A1组(既往出血<2次)、A2组(既往出血≥2次),B1组(既往出血<2次)、B2组(既往出血≥2次).A组给予生长抑素首剂4.1 ml静脉注射后,再给予生长抑素4.1 ml/h持续泵入,持续5 d.B组给予生长抑素首剂8.2 ml静脉注射后,再给予生长抑素8.2 ml/h持续泵入,持续5 d.比较A组和B组、A1组和B1组、A2组和B2组的首次止血成功率、再出血率、治疗有效率、病死率.结果 B组的首次止血成功率、治疗有效率高于A组,再出血率低于A组(P<0.05).B2组的首次止血成功率高于A2组,再出血率低于A2组(P<0.05).结论 对于肝硬化合并食管胃底静脉曲张破裂出血患者,加倍剂量生长抑素治疗是有效的,尤其是对于既往出血≥2次的患者,可以明显降低再出血率.%Objective To explore the clinical efficacy about different doses of somatostatin in the treatment of esophageal and gastric variceal bleeding in liver cirrhosis.Methods We carried out a randomized controlled clinical trial in 102 liver cirrhosis patients with esophageal and gastric variceal bleeding who hospitalized in the Emergency ICU and Department of Gastroenterology,Hainan General Hospital between 2013 and 2015 and met the inclusion riteria.They were randomized into standard-dose treatment group(group A) and double standard-dose treatment group(group B) with 51 cases in each.Based on the number of previous bleedings,group A and group B were further divided into subgroup A1(previous bleedings <2 times) and subgroup A2(previous bleedings ≥ 2 times),subgroup B1(previous bleedings <2 times),and subgroup B2(previous bleedings ≥ 2 times),respectively.The first intravenous injection dose of somatostatin was 4.1 ml,8.2 ml for group A and group B,respectively.After that,patients in group A and group B were given continuous intravenous infusion of somatostatin 4.1 ml/h,8.2 ml/h with a pump for 5 days,respectively.The success rate of first hemostasis,rebleeding rate,response rate and mortality rate were compared between group A and group B,group A1 and group B1,group A2 and group B2.Results Compared with group A,group B had higher success rate of first hemostasis(P<0.05),higher response rate(P<0.05),and lower rebleeding rate(P<0.05). The success rate of the first hemostasis in group B2 was higher than that in group A2(P<0.05),and the rebleeding rate was lower than that in group A2(P<0.05).Conclusion Double standard-dose somatostatin treatment is effective in liver cirrhosis patients with esophageal and gastric variceal bleeding,especially in those with previous bleeding ≥ 2 times,the rebleeding rate can be significantly reduced.