奥曲肽预防食管静脉曲张硬化治疗后早期再出血的临床研究

Clinical Study on the Use of Octreotide for Preventing Early Rebleeding after Endoscopic Esophageal Variceal Sclerotherapy

背景:食管静脉曲张破裂出血患者经食管静脉曲张硬化治疗(EVS)后再出血发生率仍较高,是导致肝硬化门静脉高压患者死亡的重要原因之一,尤其是早期再出血。奥曲肽能降低门静脉压力,与EVS联合应用可能降低早期再出血发生率。目的:了解EVS加用奥曲肽后降低早期再出血发生率的情况,探讨影响早期再出血发生的因素。方法:80例食管胃静脉曲张患者被随机分为试验组和对照组,每组40例。两组患者均予择期或急诊EVS,根据食管静脉曲张消失情况行3～5次EVS,每隔7d治疗1次,静脉曲张消失或基本消失为一疗程结束。试验组于第1、2、3次EVS术后第4～6d加用奥曲肽治疗。结果:试验组EVS后有1例发生早期再出血,发生率为2.5%,对照组有7例发生早期再出血,发生率为17.5%,试验组早期再出血发生率显著低于对照组(P=0.028)。Logistic逐步回归分析显示奥曲肽对早期再出血发生率有显著影响(P=0.049)。结论:EVS联合奥曲肽治疗可降低EVS后早期再出血发生率。

Background： The rebleeding rate of esophageal varices after endoscopic variceal sclerotherapy （EVS） is still high, and is one of the most important causes of death in patients with liver cirrhosis and portal hypertension, especially the early rebleeding. Octreotide can lower portal venous pressure, together with EVS it may lower the early rebleeding rate. Aims： To study whether early rebleeding rate can be lowered if octreotide was used together with EVS, and to investigate the factors which may influence the occurrence of early rebleeding. Methods： Eighty patients with esophageal and gastric varices were randomly allocated to treated group and control group with 40 patients in each group. Each patient underwent elective or emergency EVS 3-5 times once every seven days. The end point was disappearance of esophageal varices. Patients in treated group received octreotide on the 4th, 5th and 6th day after the first, second, and third EVS, respectively. Results： One patient in the treated group （2.5%） had early rebleeding, compared with seven （17.5%） in the control group. The rebleeding rate of treated group was significantly lower than that of control group （P=-0.028）. Logistic stepwise regression analysis showed that the use of octreotide had a significant effect on the occurrence of early esophageal varices rebleeding （P=0.049）. Conclusions： EVS combined with octreotide can lower the rate of early esophageal variceal rebleeding.