生长抑素、奥曲肽和垂体后叶素治疗食管静脉曲张破裂出血患者系统性和肝脏血流动力学的变化比较

Efficacy of somatostatin,octreotide and pitressin plus nitroglycerin in treatment of patients with acute variceal bleeding

目的探讨生长抑素、奥曲肽和垂体后叶素治疗门脉高压食管静脉曲张破裂出血患者血流动力学参数的变化。方法选择急性食管胃底静脉曲张破裂出血患者224例,分别应用生长抑素(A组,n=68)、奥曲肽(B组,n=73)和垂体后叶素联合硝基甘油(C组,n=83)治疗,使用彩色多谱勒超声测定肝脏和系统性血流动力学指标。结果在治疗24 h、48 h和72 h,A组和B组出血控制率分别为(67.7%、73.5%和91.2%)和(68.5%、72.6%和91.8%),均显著高于C组[分别为(50.6%、54.2%和80.0%),均P<0.05],A组和B组出血控制时间分别为(32.7±6.8)h和(33.8±8.0) h,均显著短于C组[(44.6±15.4) h,均P<0.05];在治疗过程中,三组门静脉内径(PVD)、血流速度(PVV)、血流量(PVF)和肝动脉搏动指数(HA-PI)显著减低,而在治疗后又恢复到治疗前水平;A组和B组心率和心输出量显著减少,平均动脉压无明显变化,而C组心率和平均动脉压显著增高。结论生长抑素和奥曲肽治疗食管静脉曲张破裂出血患者的疗效显著优于垂体后叶素联合硝酸甘油治疗者,其机制可能为减少了心输出量和收缩内脏血管,从而降低了门静脉血流量和门脉压力。

Objective To investigate the efficacy of somatostatin(SS),octreotide(OC)and pitressin plus nitroglycerin(PN)in the treatment of patients with acute variceal bleeding.Methods 224 patients with acute esophageal and gastric variceal hemorrhage were randomly divided into three groups,receiving SS(group,n=68),OC(group B,n=73)and pitressin plus PN(group C,n=83)treatment,respectively.The Doppler ultrasound parameters in the three groups were measured before,during and after the treatment.Results The bleeding control rates at 24 h,48 h and 72 h in group A were 67.7%,73.5%and 91.2%,and in group B were 68.5%,72.6%and 91.8%,significantly higher than 50.6%,54.2%and 80.0%in group C,respectively(P<0.05);the bleeding-controlled time in group A was(32.7±6.8)h,and in group B was(33.8±8.0)h,significantly shorter than(44.6±15.4)h in group C(P<0.05);the portal vein diameters(PVD),portal vein velocities(PVV),blood flow(PVF),and hepatic artery pulsatility index(HA-PI)in the three groups 12 h after treatment were significantly reduced as compared with those before treatment;the results of systematic hemodynamic parameters showed that the heart rates(HR)and cardiac outputs(CO)were significantly decreased,while the mean arterial pressure(MAP)did not change significantly in group A and in group B,but the HR and MAP significantly increased in group C 12 h after treatment.Conclusions SS and OC were more effective with less side effects than PN for treatment of patients with acute variceal hemorrhage,and the mechanism might be the reduction of cardiac output and contraction of visceral blood vessels,which reduce the portal vein blood flow and portal pressure.