内镜下套扎术联合聚桂醇治疗肝硬化合并上消化道出血患者的效果

Efficacy of Endoscopic Ligation Combined with Lauromacrogol on Patients with Cirrhosis Complicated with Upper Gastrointestinal Hemorrhage

目的探讨内镜下套扎术(EVL)联合聚桂醇治疗肝硬化合并上消化道出血(UGB)患者的效果。方法回顾性收集新密市第一人民医院2018年1月至2020年12月收治的136例肝硬化合并UGB患者的临床资料。按治疗方案分成常规组(68例)和联合组(68例)。常规组患者接受EVL治疗,联合组患者接受EVL联合聚桂醇治疗。比较两组治疗总有效率、停止出血时间、输血量、住院时间、呕血消失时间、黑便消失时间。比较两组治疗前后血流动力学指标(脾静脉血流量、门静脉血流量)、一氧化氮(NO)、抗利尿激素(ADH)、血浆肾素活性(PRA)、血管紧张素Ⅱ(AT-Ⅱ)、胃泌素(GAS)、去甲肾上腺激素(NE)、肾上腺素(E)、皮质醇(Cor)水平。结果联合组总有效率较常规组高(P<0.05)。联合组停止出血时间、呕血消失时间、黑便消失时间及住院时间较常规组短,输血量较常规组少(P<0.05)。治疗后,两组门静脉血流量及脾静脉血流量较治疗前少,联合组门静脉血流量及脾静脉血流量较常规组少(P<0.05)。治疗后,两组NO、ADH、PRA、AT-Ⅱ、GAS、NE、E、Cor水平较治疗前低,联合组NO、ADH、PRA、AT-Ⅱ、GAS、NE、E、Cor水平较常规组低(P<0.05)。结论采用EVL联合聚桂醇治疗肝硬化合并UGB患者的效果显著,可有效优化血流动力学指标,改善血管活性分子水平和应激状态,促进病情恢复。

Objective To investigate the effect of endoscopie ligation(EVL)combined with lauromacrogol in the treatment of patients with cirrhosis complicated with upper gastrointestinal bleeding(UGB).Methods The clinical data of 136 patients with cirrhosis complicated with UGB admitted to Xinmi First People's Hospital from January 2018 to December 2020 were collected retrospectively.According to the treatment plan,they were divided into routine group(68 cases)and combined group(68 cases).The patients in routine group were treated with EVL,while the patients in combined group were treated with EVL combined with polydecyl alcohol.The total efective rate,stopping bleeding time,blood transfusion amount,hospitalization time,hemat emesis disappearance time and melena disappearance time were compared between the two groups.Hemodynamic indexes(splenic vein blood flow and portal vein blood flow),nitric oxide(NO),antidiuretic hormone(ADH),plasma renin activity(PRA),angiotensin Ⅱ(AT-Ⅱ),gastrin(GAS),norepinephrine(NE),epinephrine(E)and cortisol(Cor)levels were compared between the two groups before and after treatment.Results The total effective rate of combined group was higher than that of routine group(P<0.05).The time to stop bleeding,disappear hemat emesis,disappear black stool and stay in hospital in combined group were shorter than those in routine group,and the amount of blood transfusion was less than that in routine group(P<0.05).After treatment,the portal vein blood flow and splenic vein blood flow in the two groups were less than those before treatment,while those in combined group were less than those in routine group(P<0.05).After treatment,the levels of NO,ADH,PRA,AT-Ⅱ,GAS,NE,E and Cor in the two groups were lower than those before treatment,while the levels of NO,ADH,PRA,AT-Ⅱ,GAS,NE,E and Cor in combined group were lower than those in routine group(P<0.05).Conclusion EVL combined with lauromacrogol has a significant effect in the treatment of patients with cirrthosis complicated with UGB,which can effectively optimize hermodynamic indexes,improve the content of vasoactive molecules and promote the recovery of the disease.