奥曲肽联合生长抑素对肝硬化上消化道出血患者肝静脉压及血流量指标的影响

Effects on hepatic vein pressure and blood flow indexes in patients with liver cirrhosis and upper gastrointestinal hemorrhage by using octreotide combined with somatostatin

目的:探究奥曲肽联合生长抑素对肝硬化上消化道出血患者肝静脉压及血流量指标的影响。方法:2018年1月~2019年3月在我院消化科100例就诊的肝硬化上消化道出血患者,随机分为生长抑素组(50例)与联合组(50例),所有患者均给予生长抑素和奥美拉唑肠溶胶囊进行治疗,联合组则在此基础上加用奥曲肽,两组患者均连续治疗4w。检测并比较两组的治疗效果、肝静脉压力指标、静脉血流量、再出血及不良反应发生情况。结果:联合组总有效率显著高于生长抑素组(94.0%vs.78.0%)。治疗后30min,两组的肝静脉游离压(FHVP)、肝静脉锲入压(WHVP)、肝静脉压力梯度(FHVP)水平均低于治疗前,且联合组的FHVP,WHVP及HVPG分别为[(6.5±1.1)mmHg、(9.8±2.7)mmHg、(6.3±2.4)mmHg],显著低于生长抑素组的[(8.3±1.8)mmHg、(17.5±3.1)mmHg、(10.3±2.2)mmHg]。治疗后,两组的脾静脉血流量、门静脉血流量均比治疗前低,且联合组的脾静脉血流量、门静脉血流量分别为[(251.1±43.2)mL/min、(495.3±51.9)mL/min],显著低于生长抑素组的[(303.4±45.1)mL/min、(615.2±63.2)mL/min]。生长抑素组患者再出血率分别为18.0%(9/50),联合组患者再出血率分别为4.0%(2/50);联合组再出血率显著低于生长抑素组(4.0%vs.18.0%),但两组患者不良反应发生率比较无统计学差异。结论:奥曲肽联合生长抑素治疗肝硬化上消化道出血临床疗效显著,可有效降低肝静脉压力、静脉血流量及再出血率,安全性较高,值得临床加以推广与应用。

Objective To investigate the effect on hepatic vein pressure and blood flow indexes in patients with liver cirrhosis and upper gastrointestinal hemorrhage by using octreotide combined with somatostatin.Methods Between January 2018 and March 2019,100 patients with liver cirrhosis and upper gastrointestinal hemorrhage were randomly divided into the somatostatin group(50 cases)and the combined group(50 cases).All patients were treated with somatostatin and omeprazole entericcoated capsules,and the combined group was additionally treated with octreotide on this basis.Both groups of patients were continuously treated for 4 weeks.The therapeutic effect,hepatic vein pressure index,venous blood flow,rebleeding and adverse reactions in the two groups were detected and compared.Results The total effective rate in the combined group was significantly higher than that the somatostatin group(94.0%vs 78.0%,).30 min after treatment,the levels of hepatic vein free pressure(FHVP),hepatic vein wedge pressure(WHVP)and hepatic vein pressure gradient(FHVP)in the two groups were all lower than those before treatment,and the levels of FHVP,WHVP and HVPG in the combined group were[(6.5±1.1)mm Hg,(9.8±2.7)mm Hg,(6.3±2.4)mm Hg],significantly lower than those in the somatostatin group[(8.3±1.8)mm Hg,(17.5±3.1)mm Hg,(10.3±2.2)mm Hg].After treatment,the splenic venous blood flow and portal vein blood flow in the two groups were lower than those before treatment,and the splenic venous blood flow and portal vein blood flow in the combined group were[(251.1±43.2)m L/min,(495.3±51.9)m L/min],respectively,significantly lower than those in the somatostatin group[(303.4±45.1)m L/min,(615.2±63.2)m L/min].The rebleeding rate in the somatostatin group was 18.0%(9/50)and that in combined group was 4.0%(2/50).The rebleeding rate in the combined group was significantly lower than that in the somatostatin group(4.0%vs.18.0%),but there was no significant difference in the incidence of adverse reactions between the two groups.Conclusion Octreotide combined with somatostatin has a significant clinical effect in the treatment of patients with liver cirrhosis and upper gastrointestinal hemorrhage.It can effectively reduce hepatic vein pressure,venous blood flow and rebleeding rate.It is safe and worthy of clinical promotion and application.