凝血酶联合生长抑素对上消化道出血患者血清炎性因子及凝血功能的影响

Thrombin combined with somatostatin for treatment of patients with upper gastrointestinal hemorrhage:Impact on inflammatory factors and coagulation function

目的探讨凝血酶联合生长抑素对上消化道出血患者血清炎性因子及凝血功能的影响.方法选择2015-07/2017-06收治的上消化道出血患者70例为研究对象,采用随机数字表法分为观察组和对照组各35例.在常规对照治疗的基础上,对照组同时给予奥曲肽治疗,观察组给予凝血酶联合奥曲肽治疗.比较两组血清炎性炎子、凝血功能、临床疗效、不良反应等指标.结果观察组平均止血时间明显短于对照组(16.75 h±3.12 h vs 25.46 h±3.45 h,t=11.078,P<0.01);有效率明显高于对照组[94.29%(33/35)vs 77.14%(27/35),χ2=4.200,P<0.05];血清肿瘤坏死因子-α(tumor necrosis factorα,TNF-α)、白介素-6(interleukin-6)含量明显低于对照组,血清IL-2含量明显高于对照组[(5.32 ng/L±0.75 ng/L vs 8.02 ng/L±1.24 ng/L),(20.12 ng/L±3.45 ng/L vs 31.26 ng/L±4.12 ng/L),(6.75 ng/L±1.02 ng/L vs 4.68 ng/L±0.76 ng/L)](t=11.022,12.264,10.349,P<0.01);血清凝血酶原时间、部分凝血活酶时间明显低于对照组血小板、纤维蛋白原明显高于对照组[(13.32 s±2.2 s vs 16.84 s±3.24 s),(33.12 s±4.56 s vs 40.18 s±5.35 s),(67.82× 10~9/L±8.36× 10~9/L vs 58.75× 10~9/L±6.82× 10~9/L),(315.45 g/L±45.24 g/L vs 284.72 g/L±40.15)g/L](t=5.249、5.942、4.973、3.006,P<0.05).结论凝血酶联合生长抑素治疗有助于缩短止血时间,提高临床疗效,可能与抑制患者炎症症状、改善凝血功能等因素有关.

AIM To evaluate the effect of thrombin combined with somatostatin on inflammatory factors and coagulation function in patients with upper gastrointestinal hemorrhage.METHODS Seventy patients with upper gastrointestinal bleeding treated from July 2015 to June 2017 were divided into either an observation group or a control group. The control group was given octreotide alone, and the observation group was given thrombin combined with octreotide. After treatment, serum inflammatory factors, coagulation function, clinical efficacy, and adverse reactions were compared between the two groups.RESULTS Time to hemostasis was significantly shorter in the observation group than in the control group （16.75 h ± 3.12 h vs 25.46 h ± 3.45 h, t = 11.078, P 〈 0.01）. The effective rate was significantly higher in the observation group than in the control group [94.29% （33/35） vs 77.14% （27/35）, Z2= 4.200, P 〈 0.05]. Serum tumor necrosis factor α （5.32 ng/L ± 0.75 ng/L vs 8.02 ng/L ± 1.24 ng/L, t = 11.022, P 〈 0.01 ） and interleukin （IL）-6 levels （20.12 ng/L ± 3.45 ng/L vs 31.26 ng/L ± 4.12 ng/L, t = 12.264, P 〈 0.01） were significantly lower and serum IL-2 （6.75 ng/L ± 1.02 ng/L vs 4.68 ng/L ± 0.76 ng/L, t = 10.349, P 〈 0.01） was significantly higher in the observation group than in the control group. Prothrombin time （13.32 s ±2.2 s vs 16.84 s 3.24 s, t = 5.249, P 〈 0.05） and activated partial thromboplastin time （33.12 s ± 4.56 s vs 40.18 s ± 5.35 s, t = 5.942, P 〈 0.05） were significantly lower, and platelets （67.82 × 10^9/L ± 8.36 × 10^9/L vs 58.75× 10^9/L - 6.82 × 10^9/L, t = 4.973,P 〈 0.05） and plasma fibrinogen （315.45 g/L ± 45.24 g/L vs 284.72 g/L ± 40.15 g/L, t = 3.006, P 〈 0.05） were significantly higher in the observation group than in the control group.CONCLUSION Thrombin combined with somatostatin can shorten hemostatic time and improve clinical efficacy in patients with upper gastrointestinal hemorrhage, which may be related to reducing inflammatory symptoms and improving coagulation function.