奥曲肽持续静脉泵入治疗恶性肠梗阻临床价值

Clinical efficacy of continuously pumped octreotide infusion in palliative treatment of malignant bowel obstruction

目的了解奥曲肽治疗恶性肠梗阻的近期疗效、安全性、中位生存期和总生存期。方法将晚期恶性肠梗阻非手术治疗患者48例分为两组:对照组(n=22)常规治疗,即禁食、鼻胃管胃肠减压、全肠外营养支持、预防感染、止痛等;治疗组(n=26)除常规治疗外,应用奥曲肽300μg/24 h持续静脉泵入。评价两组有效率,观察两组治疗开始前后的鼻胃管引流量,并统计鼻胃管拔除率。通过随访,统计两组患者的中位生存期和总生存期。结果对照组和治疗组有效率分别为22.8%和42.4%,拔管率分别为22.7%和34.6%,两组比较差异有统计学意义(P<0.05)。与对照组相比,治疗组治疗第6天胃管引流量更少(260±146)ml/d vs(505±168)ml/d,(P<0.01),PS评分改善更佳,中位生存期延长1.4周,总生存期差异无统计学意义。结论 300μg//24 h的奥曲肽治疗恶性肠梗阻具有重要的作用,有良好的安全性,可改善临床症状和PS状况,但对患者的总生存期无明显延长。

Objective To evaluate the efficacy and safety of octreotide in the management of malignant bowel obstruction （MBO）. Methods Forty - eight patients with advanced MBO were divided into two groups. Control group （ n = 22） was given routine treatment, i. e. fasting, nasogastric decompression, total parenteral nutrition （TPN）, infection prevention and analgesia. Treatment group （n = 26） addition-ally received continuously pumped octreotide（3OOμg/24h） infusion for 6 days. Patients who responded to this 6 - day course of treatment continued to receive the drug. Results The response rate was significantly higher in treatment group than in control group （42.4% vs 22. 8% , P = 0.018 ）. The extubate rate of the two groups was 22.7% and 34.6% （P 〈 0.05 ）, respectively. Compared with control group, the preferable performance status was obtained, and the less net volume of nasogastric tube drainage after 6 - day administration was found in the treatment group （260±146） ml/d vs （505±168 ） ml/d ,P 〈 0.01 ）. Conclusion The 300μg/24h dose of octreotide was safe and well tol erated. Continuous pumped treatment of octreotide has satisfactory effect on MBO and could contribute to the improvement of the performance status of patients in clinic.