雷贝拉唑联合内镜注射对非静脉曲张性上消化道出血患者再出血情况的影响

Effect of rabeprazole combined with endoscopic injection on rebleeding in patients with non-variceal upper gastrointestinal bleeding

目的探究雷贝拉唑联合内镜注射对非静脉曲张性上消化道出血患者胃酸分泌功能、炎症水平及氧化应激反应的改善情况及对再出血的预防效果。方法选取2018-06-10-2019-12-21建湖县人民医院接受治疗的非静脉曲张性上消化道出血患者156例,根据随机数字表法随机分为内镜注射组、联合治疗组,各78例。内镜注射组患者进行内镜注射肾上腺素治疗,联合治疗组患者进行雷贝拉唑联合内镜注射治疗。对比2组患者止血、血压稳定时间及出血量,对患者胃酸分泌功能进行检测,酶联免疫吸附试验法检测肿瘤坏死因子α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)水平;使用流式细胞仪对2组患者T淋巴细胞亚群水平进行检测;使用透射比浊法对2组患者免疫谷胱甘肽过氧化物酶(GSH-Px)、过氧化脂质(LPO)、丙二醛(MDA)水平进行检测;并比较2组患者治疗有效率及再出血率。结果联合治疗组患者止血、血压稳定时间均短于内镜注射组,出血量低于内镜注射组,差异有统计学意义,均P<0.05。治疗后,内经注射组[多胺氧化酶(PAO)(13.77±2.31)mmol/h、基础胃分泌量(BAO)(5.28±1.41)mmol/h、单胺氧化酶(MAO)(10.35±1.98)mmol/h]高于联合治疗组患者PAO(11.42±2.06)mmol/h、BAO(4.10±1.23)mmol/h、MAO(8.51±1.79)mmol/h,差异有统计学意义,t值分别为6.706、5.570和6.088,均P<0.05;内镜注射组[TNF-α(7.32±1.86)ng/L、IL-1β(15.31±2.56)pg/mL、IL-6(15.19±2.71)pg/mL]高于联合治疗组患者TNF-α(4.97±1.37)ng/L、IL-1β(11.59±2.34)pg/mL、IL-6(12.03±2.55)pg/mL,差异有统计学意义,t值分别为8.984、9.473和7.500,均P<0.05;与内镜注射组相比,联合治疗组患者群集分化8^(+)(CD8^(+))水平较低,群集分化4^(+)(CD4^(+))、群集分化3^(+)(CD3^(+))水平较高,差异有统计学意义,t值分别为5.666、6.006和6.166,均P<0.05);与内镜注射组相比较,联合治疗组患者GSH-Px水平较高,LPO、MDA水平较低,差有统计学意义,t值分别为6.463、7.348和5.702,均P<0.05。联合治疗组治疗总有效率[(72/78)92.31%]高于内镜注射组[(63/78)80.77%],再出血率[(3/78)3.85%]低于内镜注射组[(10/78)12.82%],差异有统计学意义,t值分别为4.457和4.112,均P<0.05。结论使用雷贝拉唑联合内镜注射对非静脉曲张性上消化道出血患者能够改善患者胃酸分泌功能、氧化应激反应及免疫功能更,降低炎症反应及在出血率,临床疗效较为可观。

Objective To explore the improvement of rebeprazole and endoscopic injection on gastric acid secretion function,inflammation level and oxidative stress response in non-varicose upper gastrointestinal bleeding patients,and the preventive effect of rebleeding.Methods A total of 156patients with non-variceal upper gastrointestinal bleeding treated in Jianhu County People’s Hospital from June 10,2018to December 21,2019were selected,which were randomly divided into endoscopic injection group and combined treatment group with 78cases each.Patients in the endoscopic injection group were treated with endoscopic epinephrine,and patients in the combined treatment group were treated with rebeprazole combined with endoscopic injection.By comparing hemostasis,blood pressure stabilization time and bleeding volume,tumor necrosis factorα(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6),T lymphocyte subsets by flow cytometry,patients were immunized with glutathione peroxidase(GSH-Px),lipid peroxide(LPO),and malondialdehyde(MDA),and evaluated efficiently.Results In the combined treatment group,the hemostasis and blood pressure stability time were shorter than that in the endoscopic injection group,and the bleeding volume was lower than that in the endoscopic injection group,and the difference was statistically significant,all P<0.05.After treatment,polyamine oxidase(PAO),basal gastric secretion(BAO),and monoamine oxidase(MAO)were(13.77±2.31)mmol/h,(5.28±1.41)mmol/h and(10.35±1.98)mmol/h,respectively,in the internal transmenstrual injection group,higher than those in the combined treatment group,where,PAO was(11.42±2.06)mmol/h,BAO was(4.10±1.23)mmol/h,and MAO was(8.51±1.79)mmol/h,and the difference was significant,t values were 6.706,5.570,6.088;P<0.05.TNF-α,IL-1β,IL-6were(7.32±1.86)ng/L,(15.31±2.56)pg/mL,and(15.19±2.71)pg/mL in the internal transmenstrual injection group,higher than those in the combined treatment group,TNF-α(4.97±1.37)ng/L,IL-1β(11.59±2.34)pg/mL,IL-6(12.03±2.55)pg/mL.The difference was significant,t values were 8.984,9.473,7.500,P<0.05;In contrast to the endoscopic injection group,the combined treatment group had low levels of cluster differentiation 8^(+)(CD8^(+)),high levels of cluster differentiation of 4^(+)(CD4^(+))and 3^(+)(CD3^(+)),and the difference was statistical significant,t values were 5.666,6.006,6.166,P<0.05;In comparison with the endoscopic injection group,patients in the combination treatment group had higher GSH-Px levels,low levels of LPO and MDA,and the difference was statistically significant,t values were6.463,7.348,5.702,P<0.05.The total response rate of the combined treatment group[(72/78)92.31%]was higher than that of the endoscopic injection group[(63/78)80.77%],and the rebleeding rate[(3/78)3.85%]was lower than that of the endoscopic injection group[(10/78)12.82%].The difference was significant,t values were 4.457,4.112,P<0.05).Conclusion Using rebeprazole and endoscopic injection can improve gastric acid secretion function,oxidative stress response and immune function,reduce inflammatory response and bleeding rate,with considerable clinical effect.