不同剂量生长抑素联合内镜下套扎术治疗肝硬化合并消化道出血的疗效及对凝血功能的影响

Effect of different doses of somatostatin combined with endoscopic loop ligation in treatment of liver cirrhosiscomplicating gastrointestinal bleeding and its influence on coagulation function

目的 比较不同剂量生长抑素联合内镜下套扎术治疗肝硬化合并消化道出血的疗效及对凝血功能的影响。方法 选取2020年1月至2022年3月来院就诊的96例肝硬化合并消化道出血患者作为研究对象,按照随机数字表法分为常规剂量组及高剂量组。两组均实施内镜下套扎术。常规剂量组予以常规剂量生长抑素(0.25μg/h持续泵注),高剂量组予以高剂量生长抑素(0.50μg/h持续泵注),均给药5 d。比较两组患者的手术指标、套扎指标、再出血率、疗效、凝血功能、不良反应、并发症发生率。结果 高剂量组术后肠鸣音恢复时间、住院时间均短于常规剂量组(P<0.05)。高剂量组总有效率高于常规剂量组(97.92%vs.85.42%,P<0.05)。高剂量组早期再出血发生率为4.17%,常规剂量组为18.75%,两组比较差异有统计学意义(P<0.05)。两组套扎次数、套扎环数、术后止血率、迟发再出血发生率比较,差异均无统计学意义(P>0.05)。治疗后两组凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)均缩短,纤维蛋白原(FIB)水平均升高,差异均有统计学意义(P<0.05);且治疗后高剂量组TT、PT、APTT均短于常规剂量组,FIB水平高于常规剂量组,差异均有统计学意义(P<0.05)。常规剂量组不良反应发生率为6.25%,高剂量组不良反应发生率为12.50%,两组不良反应发生率比较,差异无统计学意义(P=0.484)。常规剂量组并发症发生率为2.08%,高剂量组并发症发生率为4.17%,两组并发症发生率比较,差异无统计学意义(P=0.557)。结论 对肝硬化合并消化道出血的患者采用高剂量生长抑素联合内镜下套扎术治疗能提高手术效果,加快患者术后恢复,同时能改善患者的凝血功能,安全性及治疗效果也较好,值得推广。

Objective To compare the efficacy of different doses of somatostatin combined with endoscopic loop ligation in the treatment of liver cirrhosis complicating gastrointestinal bleeding and its effect on the coagulation function.Methods Ninety-six patients with liver cirrhosis complicating gastrointestinal bleeding admitted and treated in this hospital from January 2020 to March 2022 were selected as the research subjects and divided into the conventional dose group and high dose group according to the random number table method.The both groups underwent the endoscopic loop ligation surgery.The conventional dose group was given the conventional dose of somatostatin(0.25μg/h continuous pump infusion),high-dose group received the high dose somatostatin(0.50μg/h continuous pump injection,all administered for 5 d.The surgical indicators ligation indicators,rebleeding rate,efficacy,adverse reactions,coagulation function,adverse reactions,and incidence rate of complications within one month after surgery wer compared between the two groups.Results The recovery time of postoperative bowel sounds and hospitalization time in the high dose group were shorter than those in the conventional dose group(P<0.05).The total effective rate of the high dose group was higher than that of the conventional dose group(97.92%vs.85.42%,P<0.05).The incidence of early rebleeding in the high-dose group was 4.17%,while in the conventional dose group was 18.75%,and the difference between the two groups was statistically significant(P<0.05).There was no statistically significant difference in the loop ligation frequency,number of ligation rings,postoperative hemostasis rate and incidence rate of delayed rebleeding between the two groups(P>0.05).The TT,PT,and APTT after treatment in the both groups were shortened,while the FIB level was increased,and the differences were statistically significant(P<0.05);moreover,TT,PT,and APTT after treatment,in the high dose group were shorter than those in the conventional dose group,and the FIB level was higher than that in the conventional dose group,with statistical significance(P<0.05).The adverse reaction rate of the conventional dose group was 6.25%,and the adverse reaction rate of the high-dose group was 12.50%.There was no significant difference in the incidence rate of adverse reactions between the two groups(P=0.484).The complication rate of the conventional dose group was 2.08%,and the complication rate of the high-dose group was 4.17%.There was no significant difference in the incidence rate of complications between the two groups(P=0.557).Conclusion The use of high-dose somatostatin combined with endoscopic ligation for patients with liver cirrhosis and gastrointestinal bleeding can improve surgical outcomes,accelerate postoperative recovery,and improve coagulation function.It is also safe and effective,and is worth promoting.