凝血酶治疗肝性上消化道出血187例的疗效

Therapeutic efficacy of thrombin in 187 patients with liver diseases with upper alimentary tract bleeding

目的:为评估凝血酶在肝性上消化道出血的的疗效,我们对187例各型肝病合并上消化道出血患者使用凝血酶止血治疗。其中急肝6例,亚急重肝5例,慢活肝31例,肝炎后肝硬化145例。方法:①食管静脉栓塞硬化治疗;②镜下出血部位喷洒;③口服或经胃管注入。结果:22例用凝血酶栓塞者,72h内出血完全控制,7d和6周后曲张静脉消失率分别为56.1％(50/89)和82.0％(73/89)。96例镜下直接喷洒者77例显效。23例经胃管注入者17例出血停止。46例口服流血酶者44例3d内便潜血转阴。结论:凝血酶在控制肝性上消化道出血方面安全有效。可做为食管静脉栓塞剂使用。

AIM We evaluated the therapeutic efficacy of thrombin in controlling acute upper alimentary tract bleeding(UATB)of liver diseases.METHODS One hundred and eighty-seven patients included 6 patients with acute hepatitis,5 patients with subacute severe hepatitis,31 patients with chronic active hepatitis and 145 patients with posthepatitic cirrhosis.Methods on treatment:(1)Endoscopic Variceal Sclerotherapy(EVS);(2)Endoscopic spraying on bleeding site;(3)Oral or by gastric tube administration.Therapeutic efficacy was significant if bleeding was under control within 72 h.RESULTS(1)EVS:All the 22 patients with EVB were controlled.At the end of the first and sixth week,the rate of variceal erafi-cation were 56.1 %(50/89)and 82.0%(73/89),respectively.Residual varices were grade Ⅰ0-Ⅱ0.Red colour sign was negative;(2)seventy-seven of 96 patients treated with endosopic spraying showed significant efficacy.(3)Seventeen of 23 patients with UATB were stopped by gastric tube administration.Bleeling of 44 among 46 patients who took thrombin were controlled.CONCLUSION Thrombin is an effective and safe hemostatic agent in controlling UATB.It is a potental embolic agent in EVS.