奥曲肽治疗老年非静脉曲张性上消化道出血128例临床分析

Clinical Analysis of Curative Effects of Octreotide on 128 Cases with Elderly Nonvariceal Upper Gastrointestinal Bleeding

目的观察应用奥曲肽治疗老年非静脉曲张性上消化道出血的临床效果.方法应用奥曲肽治疗老年非静脉曲张性上消化道出血128例.其中,65例患者因上消化道大出血致失血性休克直接应用奥曲肽,先静注奥曲肽0.1 mg,然后静点0.3 mg,严重时可加至0.6 mg;2例D ieu lafoy（杜氏溃疡）患者采用镜下喷洒去甲肾上腺素方法;48例凝血酶效果不佳的患者应用质子泵抑制剂和止血药1 d后改用奥曲肽静点;13例患者因心脏病而未用止血药,给予奥曲肽静点,上消化道出血停止.结果本组128例中疗效显著84例,有效36例,无效8例,其中死亡3例,转外科手术5例（球部溃疡2例,胃癌2例,胃溃疡1例）.结论奥曲肽治疗上消化道出血疗效好,安全可靠,在常规止血治疗效果不佳时,应及早应用.

Objective To observe clinical effects of octreotide used for the treatment of elderly nonvariceal upper gastrointestinal bleeding.Method Octreotide was used for the treatment of 128 cases of elderly patients with upper gastrointestinal bleeding.Among them,65 patients with hemorrhagic shock resulting from the upper gastrointestinal bleeding were treated with 0.1 mg octreotide immediately,in which firstly octreotide was administered in intravenous injection and then,0.3 mg octreotide in intravenous infusion,and even octreotide was added to 0.6 mg.2 cases of the patients with Dieulafoy were treated with norepinephrine in the endoscopic spraying,48 cases who could not be cured well with thrombin were treated with octreotide in intravenous infusion instead of thrombin after they were administered a proton pump inhibitor and a hemostatic agent for one day.13 cases with heart diseases were treated with octreotide in intravenous infusion without using any hemostatic drugs,and the upper gastrointestinal bleeding stopped after the administration.Results Among the 128 cases,84 cases succeed in the treatment,36 cases were effective,8 cases in failure,and 3 cases dead,and 5 cases（2 cases of bulbar ulcer,2 cases of gastric cancer and 1 case of gastric ulcer） were turned to surgery operation.Conclusion The curative effect of octreotide used for the treatment of upper gastrointestinal bleeding is good,safe and reliable,and it should be applied as soon as possible when the curative effect of conventional hemostatic agents is poor.