施他宁在门静脉高压症断流术围手术期的应用

The application of somatostatin during the perioperation of porta-azygous disconnection for the patients with portal hypertension

目的 :研究断流术前后应用施他宁对门静脉高压症患者门静脉压力和术后并发症的影响。 方法 :对 2 0例肝功能为ChildB级门静脉高压症患者采用门奇静脉断流术治疗。患者分为两组 ,施他宁组 :与术前 1天和术后 1～5天采用微量泵经外周静脉持续 2 4h输入施他宁 ,剂量为 6mg/ 2 4h ;对照组 :患者常规行门奇静脉断流术。两组患者于术中经大网膜直接测门静脉压力 ,同时观察术中出血量、术后腹腔渗出量和并发症。并检测术前和术后第 6天血中胰高血糖素 (GLU)、一氧化氮 (NO)和内皮素 1(ET ) 1浓度。 结果 :A组患者术中门静脉压力和术后血中GLU水平显著低于B组患者 ,而NO和ET 1浓度无明显变化 ;B组术中出血量、术后腹腔渗出和并发症高于A组。结论 :门奇静脉断流术前后应用施他宁能降低门静脉压力 。

Objective:To study the effects of somatostatin on portal pressure and operative complications in patients of portal hypertension treated with porta-azygous disconnection. Methods:Twenty patients with portal hypertension were treated with azygoportal disconnection. The severity of liver disease according to the Child-Pugh's grade was B in all patients. The patients were divided into two groups. The patients in group A were treated with intravenous infusion of somatostatin (6 mg/24 h) one day before operation and five days after operation. The patients in group B were treated with azygoportal disconnection without the use of somatostatin. The portal pressure, the volume of bleeding during operation, and the ascites and complications after operation were evaluated. The serum concentration of GLU, NO and ET-1 were determined. Results:The portal pressure and GLU concentration in patients of group A were lower than those in patients of group B. There were no differences of NO, ET-1 in patients between group A and group B. The volume of bleeding, ascites and complications in patients of group B were higher than in patients of group A. Conclusion:The use of somatostatin before and after porta-azygous disconnection can decrease portal pressure. It is beneficial in reducing the volume of bleeding in operation, ascites and complications after operation.