奥曲肽辅助治疗肝硬化上消化道出血的止血效果及对血流动力学和全身应激状态的影响

Effect of octreotide on hemostatic effect, hemodynamic parameter and systemic stress state in patients with upper gastrointestinal bleeding due to cirrhosis

目的探讨奥曲肽辅助治疗肝硬化上消化道出血的止血效果及对血流动力学和全身应激状态的影响。方法选取2014年12月至2018年1月间在攀枝花市第二人民医院接受住院治疗的肝硬化上消化道出血患者79例作为研究对象,回顾治疗方案并将入组患者分为:接受常规止血方案的对照组41例和接受常规+奥曲肽辅助止血治疗的奥曲肽组38例。比较两组患者治疗72 h后的止血效果、门静脉及脾静脉相关血流动力学参数水平及血清中氧化应激指标含量的差异。结果治疗72 h后,奥曲肽组患者的治疗总有效率97.37%,高于对照组患者85.37%,差异有统计学意义(P<0.05)。奥曲肽组患者门静脉、脾静脉的内径(D)、血流量(Q)水平低于对照组患者,差异有统计学意义(P<0.05)。奥曲肽组患者血清中氧化应激指标丙二醛(MDA)、脂质过氧化氢(LHP)的含量低于对照组患者,谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)的含量高于对照组患者,差异均有统计学意义(P<0.05)。结论肝硬化上消化道出血患者在常规止血治疗基础上加入奥曲肽进行联合治疗,可进一步提升止血效果、优化机体门静脉及脾静脉血流动力学,最终降低机体氧化应激反应程度。

Objective To study the effect of octreotide on hemostatic effect,hemodynamic parameter and systemic stress state in patients with upper gastrointestinal bleeding due to cirrhosis.Methods 79 cases of upper gastrointestinal bleeding due to cirrhosis patients treated in our hospital during December 2014 to January 2018 were chosen as research subjects,treatment schemes were reviewed and all patients were divided into control group(n=41)underwent conventional hemostasis,octreotide group(n=38)underwent routine+octreotide assisted hemostasis.The hemostatic effect,blood hemodynamic parameters of portal vein and splenic vein,serum contents of oxidative stress indexes after 72 h hemostasis between two groups were compared.Results 72 h after treatment,the total effective rate of patients in the octreotide group was higher than those of other groups,the difference was statistically significant(97.37%vs.85.37%,P<0.05);portal and splenic veins D and Q levels were lower than those in control group;and serum contents of MDA,LHP were lower than those in control group,contents of GSH-Px,SOD were higher than those in control group(P<0.05).Conclusion Octreotide combines with conventional hemostatic therapy in upper gastrointestinal bleeding patients,which can further improve the hemostatic effect,optimize the hemodynamics of the portal and splenic vein,eventually reduce the degree of oxidative stress.