血管加压素治疗肝硬化食管静脉曲张破裂出血的多中心随机对照研究

Effect of vasopressin(Pitressin)on esophageal variceal bleeding in patients with cirrhosis,A multicenter,randomized,controlled trial

目的验证血管加压素治疗肝硬化食管静脉曲张破裂出血的临床疗效。方法北京地区12家医院采用多中心、随机、对照研究方法,将42例经胃镜检查证实为急性食管静脉曲张破裂出血(EVB)的病人随机分为2组,分别给予人工合成的血管加压素(商品名必压生)和垂体后叶素治疗,通过三腔管的胃管抽吸胃内容物观察止血情况,并记录病人的输血量和药物的不良反应。结果必压生组12小时内的完全止血率为72.7%,显著高于垂体后叶素组(40.0%)(P<0.05);必压生组完全止血所需时间为8.74±7.77小时,明显短于垂体后叶素组(22.2±17.5小时)(P<0.05);必压生组的平均输血量也明显少于垂体后叶素组(P<0.05);但两组病人治疗后1周内的再出血率和生存率均差异无显著性(P>0.05):必压生组和垂体后叶素组不良反应发生率分别为40.9%和40%,均无严重药物不良反应,两组不良反应比较差异无显著性。结论必压生能有效、快速控制 EVB,其作用优于垂体后叶素。

Objective To evaluate the efficacy and safety of vasopressin(Pitr- essin)on esophageal variceal bleeding in patients with cirrhosis.Methods 42 cirrhotic patients with acute esophageal variceal bleeding confirmed by endoscopy were randomly divided into 2 groups and administered with Pitressin and Pituitrin for 48 hrs respectively.The balloon tubes were placed in the stomach before the treatment,and the duration of hemostatsis,volume of transfusion,rebleeding and short-term survival period were recorded.Results After 12 hrs treatment,the hemostatic rate in Pitressin group was 72.7%,significantly higher than that in Pituitrin group(40.0%,P<0.05).The mean duration of cesstation of bleeding in Pitressin group was 8.74±7.77 hrs,significantly shorter than that in Pituitrin group (22.2±17.5 hrs,P<0.05).The quantity of blood transfusion in Pitressin group was significantly less than that in Pituitrin group(P<0.05).But there were no significant differences in the rate of rebleeding,survival period and adverse effects between the two groups.Conclusion Pitressin can effectively and rapidly control the es- ophagesl variceal bleeding.