两种联合药物方案治疗急性上消化道曲张静脉破裂出血临床对比研究

Clinical comparative study of two combined drug regimens in the treatment of acute upper gastrointestinal varices bleeding

[目的]研究奥曲肽与生长抑素联合奥美拉唑2种不同的联合药物方案对急性上消化道曲张静脉破裂出血患者的临床疗效的影响。[方法]选取2013年1月~2016年12月我院收治的急性上消化道曲张静脉破裂出血患者130例为研究对象,用随机数表法分为对照组和试验组,每组各65例。对照组患者采用生长抑素联合奥美拉唑,试验组患者应用奥曲肽联合奥美拉唑,2组患者均治疗7d。观察比较2组患者治疗效果、输血量、止血时间、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、1周内再出血率及不良反应发生率。[结果]2组患者在年龄、性别、pH值等方面差异无统计学意义。2组患者临床疗效有效率分别为76.92%及92.31%,差异有统计学意义(P<0.05)。观察组患者在输血量、止血时间、PT、APTT均低于对照组,且观察组1周内再出血率为4.62%,明显低于对照组的再出血率的15.38%,2组患者在输血量、止血时间、PT、APTT、1周内再出血率差异均有统计学意义(P<0.05)。观察组出现3例头痛,6例恶心呕吐,2例腹痛,4例腹泻,不良反应发生率为23.08%,对照组出现2例头痛,8例恶心呕吐,3例腹痛,3例腹泻,不良反应发生率为24.62%,2组差异无统计学意义。[结论]奥曲肽联合奥美拉唑相较于生长抑素联合奥美拉唑,在治疗上消化道曲张静脉破裂出血具有较好的临床效果,能减少输血量、止血时间,降低再出血率、凝血酶原时间、活化部分凝血活酶时间,但两者不良反应发生率并无明显差异。

[Objective]To study the effect of octreotide and somatostatin combined with omeprazole on two patients with acute variceal bleeding.[Methods]130 cases with acute upper gastrointestinal variceal bleeding in our hospital were selected as the research object from January 2013 to December 2016,randomly divided into control group and test group,65 cases in each group.The control group was treated with somatostatin combined with Omeprazole,and the experimental group was treated with Octreotide combined with Omeprazole.The two groups were treated for 7 days.To observe and compare the effect of two groups of patients,blood transfusion volume,bleeding time,prothrombin time（PT）,activated partial thromboplastin time（APTT）,within a week the rebleeding rate and the incidence of adverse reactions.[Results]There was no significant difference between the 2 groups in age,sex,pH value.The effective rates of the two groups were 76.92% and 92.31% ,respectively,and the difference was statistically significant（P0.05）.Patients in the observation group were lower than the control group in blood transfusion,hemostatic time,PT,APTT,and the observation group within a week of rebleeding rate was 4.62% ,significantly lower than the control group the rebleeding rate 15.38% ,two groups of patients with blood transfusion,hemostatic time,PT,APTT,within a week the rebleeding rate differences were significant（P0.05）.Observation group with 3 cases of headache,3 cases of chest tightness,2 cases of abdominal pain,4 cases of diarrhea,3 cases of heart palpitations,incidence of adverse reaction was 23.08% .The control group with 2 cases of headache,4 cases of chest tightness,3 cases of abdominal pain,3 cases of diarrhea,4 cases of heart palpitations,incidence of adverse reaction was 24.62% .The adverse reaction was no significant difference between two groups（P0.05）.[Conclusion]Comparison of Octreotide combined with Omeprazole and somatostatin in combination with Omeprazole,Octreotide combined with Omeprazole in treatment of upper gastrointestinal variceal bleeding has good clinical effect of rupture,which can reduce the amount of blood transfusion,the bleeding time,the rate of rebleeding,prothrombin time,activated partial thromboplastin time.However,there was no significant difference in the incidence of adverse reactions between two groups.