不同剂量生长抑素联合普萘洛尔对肝硬化伴食管胃底静脉曲张破裂出血的疗效及不良反应分析

Efficacy of Different Doses of Somatostatin Combined with Propranolol on Liver Cirrhosis with Esophagogastric Variceal Bleeding and Adverse Reactions

目的评价不同剂量生长抑素联合普萘洛尔对肝硬化伴食管胃底静脉曲张破裂出血(EVB)的疗效及不良反应。方法选取2016年5月—2018年5月收治的肝硬化伴EVB患者90例,按生长抑素剂量的不同将患者分为低剂量组与加倍剂量组,每组45例。2组均予以生长抑素联合普萘洛尔治疗,低剂量组每次给予生长抑素250μg,加倍剂量组每次给予生长抑素500μg。比较2组的治疗相关指标、再出血以及不良反应发生情况,比较治疗前后的门静脉压(PVP)、门静脉血流速度(VPV)、门静脉血流量(QPV)、门静脉内径(DPV)。结果加倍剂量组止血时间、住院时间明显短于低剂量组,输血量明显低于低剂量组(P<0.01)。治疗后,2组PVP、QPV、DPV较治疗前明显降低,加倍剂量组降低幅度大于低剂量组(P<0.05)。治疗后,2组VPV比较差异无统计学意义(P>0.05)。加倍剂量组出血后1、3、6、12个月内再出血率明显低于低剂量组(P<0.05)。2组不良反应总发生率比较差异无统计学意义(P>0.05)。结论加倍剂量生长抑素联合普萘洛尔治疗肝硬化伴EVB效果更好,能够明显改善围术期指标,调节血流动力学,降低出血后1年内再出血率。

Objective To evaluate the efficacy of different doses of Somatostatin combined with Propranolol on liver cirrhosis with esophagogastric variceal bleeding(EVB)and adverse reactions.Methods A total of 90 patients with liver cirrhosis and EVB who were admitted from May 2016 to May 2018 were selected,and the patients were divided into low-dose and double-dose groups according to the different doses of Somatostatin,with 45 cases in each group.Both groups were treated with Somatostatin combined with Propranolol,the low-dose group was given 250μg Somatostatin each time,and the double-dose group was given 500μg Somatostatin each time.The treatment-related indicators,rebleeding and adverse reactions of the two groups were compared,and the portal venous pressure(PVP),velocity of portal vein(VPV),blood flow of portal vein(QPV),diameter of portal vein(DPV)before and after treatment were compared.Results The hemostasis time and length of hospital stay in the double-dose group were significantly shorter than those of the low-dose group,and the blood transfusion volume was significantly lower than that of the low-dose group(P<0.01).After treatment,the PVP,QPV and DPV of the two groups were significantly lower than those before treatment,and the reduction in the double-dose group was greater than that of the low-dose group(P<0.05).After treatment,there was no statistically significant difference in VPV between the two groups(P>0.05).The rate of rebleeding within 1,3,6 and 12 months after bleeding in the double-dose group was significantly lower than that in the low-dose group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion Double-dose Somatostatin combined with Propranolol has better effects in the treatment of liver cirrhosis with EVB,which can significantly improve perioperative period indicators,regulate hemodynamics,and reduce the rate of rebleeding within 1 year after bleeding.