生长抑素联合奥曲肽治疗肝硬化并发上消化道出血患者疗效及其对凝血功能指标的影响再观察

Efficacy and impact on blood coagulation functions of somatostatin and octreotide combination in the treatment of cirrhotic patients with upper gastrointestinal hemorrhage

目的分析生长抑素联合奥曲肽治疗肝硬化并发上消化道出血患者疗效及其对凝血功能指标的影响。方法2017年7月~2019年5月我院消化内科收治的肝硬化并发上消化道出血患者70例,采用随机数字表法将患者分为对照组35例和观察组35例。给予对照组静脉滴注奥曲肽,给予观察组奥曲肽联合生长抑素静脉滴注治疗3~7 d,随访1 w。使用CS-5100型全自动凝血分析仪检测血清凝血酶原时间(PT)、凝血酶时间(TT)、部分凝血酶活时间(APTT)和纤维蛋白原(FIB)水平。结果在治疗2 w末,观察组血清白蛋白水平为(33.5±3.1)g/L,显著高于对照组【(31.8±2.3)g/L,P<0.05】,而血清总胆红素和血氨水平分别为(30.9±10.2)μmol/L和(32.5±11.8)μmol/L,显著低于对照组【(41.4±14.3)μmol/L和(45.2±14.6)μmol/L,P<0.05】;观察组PT水平为(12.4±1.9)s,显著短于对照组【(14.1±2.3)s,P<0.05】,TT为(18.2±2.1)s,显著短于对照组【(20.4±2.5)s,P<0.05】,APTT为(34.5±4.8)s,显著短于对照组【(37.3±5.2)s,P<0.05】,FIB水平为(2.4±0.6)g/L,显著高于对照组【(2.1±0.5)g/L,P<0.05】;观察组止血时间和住院日为(20.7±3.1)h和(8.5±2.3)d,显著短于对照组【(24.6±3.9)h和(10.3±2.5)d,P<0.05】,72 h再出血发生率为5.7%,显著低于对照组的20.0%(P<0.05)。结论应用生长抑素联合奥曲肽治疗肝硬化并发上消化道出血患者能显著减少输血量,缩短止血时间和住院日,可能与改善了凝血功能异常有关。

Objective The aim of this study was to analyze the efficacy and impact on blood coagulation functions of somatostatin and octreotide combination in the treatment of cirrhotic patients with upper gastrointestinal hemorrhage.Methods 70 cirrhotic patients with upper gastrointestinal hemorrhage were admitted to our hospital between July 2017 and May 2019,and they were randomly divided into control and observation group,with 35 cases in each.The patients in the control group were treated by intravenous infusion of octreotide and those in the observation group were treated by intravenous infusion of somatostatin and octreotide combination for 3 to 7 days.All patients were followed-up for two weeks.Blood prothrombin time(PT),thrombin time(TT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)were monitored.Results At the end of two week treatment,blood albumin level in the combination group was(33.5±3.1)g/L,significantly higher were than【(31.8±2.3)g/L,P<0.05】,while serum bilirubin and blood ammonia levels(30.9±10.2)μmol/L and(32.5±11.8)μmol/L,much lower than【(41.4±14.3)μmol/L and(45.2±14.6)μmol/L,respectively,P<0.05】in the control;the PT was(12.4±1.9)s,significantly shorter than【(14.1±2.3)s,P<0.05】,the TT was(18.2±2.1)s,significantly shorter than【(20.4±2.5)s,P<0.05】,the APTT was(34.5±4.8)s,much shorter than【(37.3±5.2)s,P<0.05】,and the FIB level was(2.4±0.6)g/L,significantly higher than【(2.1±0.5)g/L,P<0.05】in the control;the hemostasis time and hospital stay in the combination group were(20.7±3.1)h and(8.5±2.3)d,significantly shorter than【(24.6±3.9)h and(10.3±2.5)d,P<0.05】in the control,and the incidence of 72 hour re-bleeding was 5.7%,significantly lower than 20.0%(P<0.05)in the control.Conclusion The combination of somatostatin and octreotide in the treatment of cirrhotic patients with upper gastrointestinal hemorrhage greatly reduce the amount of blood transfusion,shorten the hemostasis time and hospital stay,which might be related to the correction of abnormal coagulation function.