内科经验性治疗肝硬化合并上消化道出血304例临床研究

Clinical study of 304 cases with internal medicine empirical treatment of liver cirrhosis with upper gastrointestinal hemorrhage

目的分析肝硬化合并上消化道出血联合使用不同止血药物的疗效。方法选择2010年11月至2013年11月铁岭市中心医院肝硬化合并上消化道出血患者304例,随机分为治疗组152例与对照组152例,两组患者均采用内科消化道出血常规治疗(包括抗感染、补液、保肝及心理治疗)。治疗组患者在此基础上加用注射用奥曲肽、注射用氨甲环酸、注射用蛇毒血凝酶、注射用泮托拉唑等静脉输注止血、对症治疗;对照组加用注射用奥曲肽、注射用奥美拉唑、注射用止血芳酸静脉输注,注射用维生素K及注射用肾上腺色腙肌注,凝血酶冻干粉口服等止血对症治疗。结果治疗组总有效率为98.68%,对照组为86.84%,两组差异有统计学意义(P=0.0001)。结论内科药物经验性的综合应用能够有效治疗肝硬化合并上消化道出血,提高治愈率,减少病死率,经济高效,值得临床推广。

Objective To analyze the effect of combined using different hemostatic drugs to treat liver cirrhosis with upper gastrointestinal hemorrhage. Methods From November 2010 to November 2013, 304 patients of liver cirrhosis with upper gastrointestinal hemorrhage were randomly divided into treatment group （152 cases） and control group （152 cases）. Two groups were given medical conventional treatment of gastrointestinal bleeding （including resistance to infection, fluid infusion, protecting liver and psychotherapy）. On this basis, the treatment group was given octreotide, tranexamic acid, hemocoagulase and pantoprazole intravenous drip to stop bleeding and expectant treatment. And the control group was given octreotide, omeprazole and p-aminomethyl benzoic acid intravenous drip, vitamin K and adrenochrome semicarbazone intramuscular injection, and lyophilizing thrombin powder oral for hemostasis treatment. Results Total effective rate of treatment group was 98.68% and control group was 86.84% , two groups showed statistically significant （P = 0.0001）. Conclusions Internal medicine empirical comprehensive application can effectively treat liver cirrhosis with upper gastrointestinal hemorrhage, improve the cure rate, reduce mortality, economic efficiency, worth clinical promotion.