膈下逐瘀汤联合奥曲肽、凝血酶对肝硬化合并胃食管静脉曲张出血患者肝功能及血清NO、ACE的影响

Influence of infradiaphragmatic stasis-expelling decoction combined with octreotide,thrombin on liver function and serum NO and ACE of patients with cirrhosis complicated with gastroesophageal varices blood

[目的]探讨膈下逐瘀汤联合奥曲肽、凝血酶对肝硬化合并胃食管静脉曲张出血患者肝功能及血清一氧化氮(NO)、血管紧张素转换酶(ACE)水平的影响。[方法]选取来我院就诊的96例肝硬化并发胃食管静脉曲张出血患者为研究对象,随机分为对照组和观察组,各48例。对照组给予奥曲肽、凝血酶治疗,观察组在对照组治疗的基础上加用膈下逐瘀汤治疗。比较2组治疗后临床疗效,观察2组治疗前后血清天门冬氨酸氨基转氨酶(AST)/氨酸氨基转氨酶(ALT)、血清白蛋白(ALB)/血清胆碱酯酶(ChE)比值、Child-pugh分级及血清NO、ACE水平的变化,统计2组在治疗过程中出现的不良反应症状及半年内再次出血发生率。[结果]治疗后,观察组的总有效率明显高于对照组(P<0.05);2组患者的血清AST/ALT与ALB/ChE比值较治疗前均明显降低(P<0.01),且观察组明显低于对照组(P<0.05或P<0.01);与对照组比较,观察组Child-pugh A级患者明显升高、Child-pugh C级明显降低(P<0.05),Child-pugh B级差异无统计学意义;2组血清NO、ACE水平较治疗前均明显下降(P<0.01),且观察组明显低于对照组(P<0.01);治疗过程中,观察组不良反应发生率明显低于对照组(P<0.05),且半年内无再出血现象,复发率为0。[结论]膈下逐瘀汤联合奥曲肽、凝血酶治疗肝硬化合并胃食管静脉曲张出血效果显著且安全性高,值得临床推广应用。

[Objective]To explore the effect of infradiaphragmatic stasis-expelling decoction combined with octreotide and thrombin on liver function and serum nitric oxide（NO）,angiotensin converting enzyme（ACE）levels of patients with cirrhosis complicated with gastroesophageal varices bleed.[Methods]96 cases of patients with cirrhosis complicated with gastroesophageal varices bleed treated in our hospital were selected as the study objects,and were divided into control group and observation group randomly,with 48 cases in each group.The control group were given octreotide,thrombin treatment,and the observation group were given infradiaphragmatic stasis-expelling decoction treatment.Clinical efficacy were compared after treatment,serum aspartate aminotransferase（AST）/lysine aminotransferase（ALT）,serum albumin（ALB）/serum cholinesterase（ChE）ratio,Child-pugh classification,and serum NO and ACE levels were observed before and after treatment,and the incidence of adverse reactions and rebleeding in half a year was figured in the two groups.[Results]After treatment,total effective rate of the observation group was signif-icantly higher than that of the control group（P0.05）.The ratios of serum AST/ALT and ALB/ChE were significantly lower than those before treatment in the two groups（P0.01）,and those in the observation group were significantly lower than those in the control group（P0.05,P0.01）.Child-pugh class A patients increased,Child-pugh C class decreased when compared with that in the control group（P0.05）,but there were no significant difference in Child-pugh B class.Serum NO and ACE levels were significantly lower than those before treatment in the two groups（P0.01）,and those in the observation group were significantly lower than those in the control group（P0.01）.The incidence of adverse reactions in the observation group was significantly lower than that in the control group（P0.05）.There was no rebleeding in half a year,and the recurrence rate was 0.[Conclusion]The effect is obvious of infradiaphragmatic stasis-expelling decoction combined with Octreotide in treatment of patients with cirrhosis complicated with gastroesophageal varices bleed,with high safety.It is worthy of clinical application.