奥曲肽治疗对食管胃底静脉曲张出血的肝静脉压力梯度及血流速度的影响观察

中国临床药理学与治疗学 ›› 2015, Vol. 20 ›› Issue (4): 441-444.

奥曲肽治疗对食管胃底静脉曲张出血的肝静脉压力梯度及血流速度的影响观察

吴春松¹, 张玲², 周玮², 冯贻征³, 朱鹏武¹

¹浙江省临海市第一人民医院消化内科, 临海 317000,浙江;
²第二军医大学附属长海医院消化内科,上海 200433;
³浙江省临海市第一人民医院放射科, 临海 317000,浙江

收稿日期:2014-03-27 修回日期:2014-06-23 发布日期:2015-05-07
作者简介:吴春松,男,硕士,主治医师,主要从事肝胆、胃肠临床研究。E-mail: wcsheaven@sina.com

A clinical observation of hepatic vein pressure gradient and flow rate after Octreotide treatment of bleeding esophageal varices

WU Chun-song¹, ZHANG Ling², ZHOU Wei², FENG Yi-zheng³, ZHU Peng-wu¹

¹ Department of Gastroenterology, the First Poeple's Hospital of Linhai, Linhai 317000, Zhejiang, China;
² Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China;
³ Radiology Department, the First Poeple's Hospital of Linhai, Linhai 317000, Zhejiang, China

Received:2014-03-27 Revised:2014-06-23 Published:2015-05-07

摘要/Abstract

摘要： 目的: 观察奥曲肽治疗肝硬化门静脉高压食管胃底静脉曲张出血肝静脉压力梯度(HVPG)等的变化,探讨奥曲肽止血机制。方法: 采用随机对照的方法,病例分为低剂量奥曲肽治疗组(A组,n=18);高剂量奥曲肽治疗组(B组,n=18)和对照组(C组,n=18)。治疗肝硬化食管胃底静脉曲张出血,在基础治疗(禁食、输液、输血、对症处理)的基础上,全部病例予以奥美拉唑注射液 40 mg,每 12 h 1次静脉滴注抑酸。治疗组A、B组分别以奥曲肽注射液25、50 μg/h 的速度微泵静脉维持治疗。观察治疗前后HVPG,门静脉内径,血流速度及呕血、黑便等的改变情况。结果: 治疗前与治疗后24、 72 h,两治疗组HVPG比较对照组显著降低,有统计学差异(P=0.00,P=0.00)。而治疗组A、B治疗后 24 h HVPG有统计学差异(P=0.00),治疗后 72 h HVPG 无统计学差异(P=0.14)。治疗组比较对照组门静脉内径减小有统计学差异(P<0.05);治疗组A、B与对照组在治疗24、72 h 呕血,黑便量相比较明显减少,有统计学差异(P<0.05)。结论: 奥曲肽能显著降低HVPG,减少门静脉内径,较高浓度奥曲肽在24 h内疗效更快,奥曲肽联合奥美拉唑比较单独奥美拉唑止血疗效更显著。

关键词: 奥曲肽, 食管静脉曲张出血, 肝静脉压力梯度, 门静脉血流速度

Abstract: AIM: To observe the change of hepatic vein pressure gradient (HVPG) after Octreotide treatment of bleeding esophageal varice (BEV).METHODS: BEV patients were randomly assigned to low dose Octreotide group (group A, n=18); high dose octreotide group (group B, n=18) and control group (n=18). The three groups were treated by the same basic method (abrosia, transfusion, blood transfusion and symptomatic treatment). Patients in group A and B were administered octreotide at a rate of 25 μg/h and 50 μg/h respectively. HVPG and other clinical parameters of patients in all the groups were observed and comparatively analyzed.RESULTS: The HVPG of patients in group A and B were significantly different before and after 24 h and 72 h post-octreotide treatment compared with that of group C (P=0.00,P=0.00). There was a significant difference between group A and group B after 24 h octreotide treatment also(P=0.00), but There was no significant difference after 72 h (P=0.14).CONCLUSION: Octreotide is effective in the treatment of BEV by reducing HVPG and its effect is significantly different from omeprazole monotherapy.

Key words: Octreotide, esophageal varices bleeding, hepatic vein pressure gradient, flow rate

中图分类号:

R571

吴春松, 张玲, 周玮, 冯贻征, 朱鹏武. 奥曲肽治疗对食管胃底静脉曲张出血的肝静脉压力梯度及血流速度的影响观察[J]. 中国临床药理学与治疗学, 2015, 20(4): 441-444.

WU Chun-song, ZHANG Ling, ZHOU Wei, FENG Yi-zheng, ZHU Peng-wu. A clinical observation of hepatic vein pressure gradient and flow rate after Octreotide treatment of bleeding esophageal varices[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2015, 20(4): 441-444.

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