奥曲肽持续皮下泵入治疗恶性肠梗阻的临床观察

Clinical observation of continuously subcutaneous-pumped octreotide infusion in palliative treatment of malignant bowel obstruction

目的观察奥曲肽持续皮下泵入给药在恶性肠梗阻姑息性治疗中的作用。方法收集2007年3月至2009年4月收治的26例恶性肠梗阻患者进行回顾分析。分为奥曲肽组11例和对照组15例,比较两组患者在治疗前后肠梗阻相关症状变化、肛门恢复排气排便时间、胃肠减压引流液量、鼻胃管留置时间、拔管率和肠梗阻近期疗效。结果奥曲肽组肠梗阻相关症状改善率为81.8%(9/11),明显优于对照组46.7%(7/15)。奥曲肽组患者恢复排气排便所需平均时间为3.2天,明显优于对照组5.8天。奥曲肽组鼻胃管留置时间为(5±1.2)天,拔管率为54.5%,均明显优于对照组(10±2.3)天和20.0%。奥曲肽组肠梗阻的近期疗效好转率为72.7%,优于对照组26.7%。结论奥曲肽持续皮下泵入给药配合常规治疗,能够显著改善晚期恶性肠梗阻患者,尤其是终末期患者的生活质量,为恶性肠梗阻的治疗提供了一种新的治疗思路和方法 。

Objective To investigate the effectiveness of continuously subcutaneous-pumped octreotide infusion in palliative treatment of malignant bowel obstruction（MBO） due to advanced carcinoma patients.Methods Clinical data were retrospectively analyzed in 26 carcinoma patients complicated with malignant bowel obstruction,in hospital affiliated to liaoning university of traditional chinese medicine from March 2007 to April 2009.Twenty-six carcinoma patients with MBO were divided into two groups：control group（routine therapy,15patients） and stilamin group（11patients）.Stilamin group（SG） received routine therapy combined with stilamin（0.3mg/d） by 24 hours continuous subcutaneous stilamin infusion.The curative effectiveness related symptom change,the time that the anus restores the exhaust bowel movement is require,liquid volume stomach and intestines reduced pressure drainaged,nasal-stomach tube leaving time and extubation rate were observed and compared between the two groups.Results After treatment,remarkable changing rate of MBO related symptom was 81.8%（9/11） in SG,46.7%（7/15） in CG（control gruop）（P0.05）.78% of SG and 30% of CG resumed the bowel movement exhaust,the mean time were 3.2 days and 5.8 days,respectively（P0.05）.The Nasal-stomach tube leaving time of SG and control group was（5.0±1.2） days and（10.0±2.3） days,decannulation rate was 54.5%vs.20.0%.Comparison in the improvement rate between the two groups,it was better in the stilamin group than that in the control group and the differences were significant（72.7%vs.26.7%,P0.05）.Conclusion The administration of stilamin,in combination with routine treatment can be very effective in the management of MBO.It can relieve the symptoms of MBO effectively and improve the quality of life in end-stage patients.It has provided a new kind of treatment thought and the method for treatment of malignant bowel obstruction.