生长抑素治疗肝硬化急性食管静脉曲张破裂出血疗效及影响因素研究

Clinical effect of somatostatin for treating hepatic cirrhotic patients with esophageal variceal bleeding and the influence factors

目的观察生长抑素治疗肝硬化急性食管静脉破裂出血的疗效,分析相关因素对疗效的影响。方法选取我院73例急性食管胃静脉破裂的肝硬化患者为研究对象,观察生长抑素等内科治疗的临床疗效,根据止血成功与否分为成功组和失败组,比较两组患者临床因素的差异,将有意义的单因素进行Logistic多因素回归分析,研究止血失败的影响因素。结果止血成功48例,失败25例,成功率为65.8%。比较两组患者的各项临床指标,差异具有统计学意义的单因素分别为出血程度、Child-pugh分级、PVD、SVD、PT和PTA(P<0.05)。多因素Logistic回归分析发现,出血程度、Child-pugh分级、PVD、SVD是影响止血效果的独立影响因素(P<0.05)。结论出血严重程度和Child-pugh分级是生长抑素治疗成功与否的主要影响因素,降低PVD和SVD扩张程度对提高止血效果有一定的帮助。

Objective To observe the clinical effect of somatostatin in the treatment of hepatic cirrhosis with acute esophageal variceal bleeding, and to study the factors that influence the treatment outcome. Methods Seven-ty-three patients who had hepatic cirrhosis with acute esophageal variceal bleeding were enrolled in this study. All the patients received somatostatin treatment. Based on the cure effect, the patients were divided into two groups： the success group and failure group. Comparison was made between the two groups to find single factors of signifi-cance. Multivariate logistic regression was then performed to analyze the factors that influence the treatment out-come. Results Forty-eight patients stopped bleeding and 25 patients failed in hemostasis, with the effective rate of 65.8%. Single factors such as amount of bleeding, Child-pugh grade, prothrombin active （PTA）, the inner-diameter of the portal vein and splenic vein （PVD, SVD） showed statistically significant difference between two groups. Multivari-ate logistic regression showed that amount of bleeding, Child-pugh grade, PVD and SVD were independent factors that influence the treatment outcome. Conclusion The amount of bleeding, Child-pugh grade are the main factors that influence the treatment outcome of somatostatin. Lowering expansion degree of PVD and SVD could help im-prove the cure effect.