生长抑素针联合三腔两囊管治疗肝硬化合并EGVB患者的效果

Effect of somatostatin needle combined with three-lumen and two-balloon catheter in the treatment of patients with liver cirrhosis complicated with EGVB

目的观察生长抑素针+三腔两囊管对肝硬化合并食管胃底静脉曲张破裂出血(EGVB)患者的疗效。方法本文为前瞻性随机对照试验,选取2020年1月至2022年5月期间南阳医学高等专科学校第一附属医院收治的65例肝硬化合并EGVB患者为研究对象,采用计算机随机数字表法将其分为观察组(33例)和对照组(32例)。观察组男20例、女13例,年龄(65.11±0.22)岁;对照组男22例、女10例,年龄(65.14±0.16)岁。两组患者均予以三腔两囊管治疗,观察组采用生长抑素针辅助治疗。比较两组患者治疗后不同时间点止血成功率、治疗前后胃肠激素、血流动力学指标以及治疗后临床指标、不良反应发生情况。采用χ^(2)检验、独立样本t检验。结果在不同治疗方案下,观察组治疗8、12、24 h后止血成功率[33.33%(11/33)、60.61%(20/33)、90.91%(30/33)]均高于对照组[18.75%(6/32)、43.75%(14/32)、68.75%(22/32)],差异均有统计学意义(均P<0.05)。治疗前,两组患者生长激素(SS)、胃泌素(GAS)、胃动素(MLT)水平比较,差异均无统计学意义(均P>0.05);治疗后,观察组SS[(15.24±0.12)ng/L]、GAS[(80.26±0.32)ng/L]、MLT水平[(211.32±5.16)ng/L]均低于对照组[(15.63±0.82)ng/L、(80.65±0.88)ng/L、(218.41±5.32)ng/L],差异均有统计学意义(均P<0.05)。治疗前,两组患者中心静脉压(CVP)、门静脉压(PVP)比较,差异均无统计学意义(均P>0.05);治疗后,观察组CVP[(9.15±0.27)mmHg(1 mmHg=0.133 kPa)]、PVP[(25.14±0.27)mmHg]均低于对照组[(9.58±0.82)mmHg、(25.56±0.85)mmHg],差异均有统计学意义(均P<0.05)。治疗后,观察组止血时间[(20.25±0.33)min]、输血量[(266.42±10.45)ml]、再出血率[6.06%(2/33)]均低于对照组[(20.77±0.82)min、(275.33±10.28)ml、18.75%(6/32)],差异均有统计学意义(均P<0.05)。治疗后,观察组不良反应发生率[12.12%(4/33)]与对照组[9.38%(3/32)]比较,差异无统计学意义(P>0.05)。结论在予以肝硬化合并EGVB患者三腔两囊管治疗同时联合应用生长抑素针可增强止血效果,对进一步抑制患者胃肠激素、改善血流动力学、缩短止血时间、减少输血量、降低再出血风险均有积极意义,未明显增强不良反应发生风险,安全性较高。

Objective To observe the effect of somatostatin needle+three-lumen and two-balloon catheter on patients with liver cirrhosis complicated with esophageal and gastric variceal bleeding(EGVB).Methods It was a prospective randomized controlled trial.A total of 65 cirrhosis with EGVB patients admitted to The First Affiliated Hospital of Nanyang Medical College from January 2020 to May 2022 were selected as the research objects.They were divided into an observation group(33 cases)and a control group(32 cases)by the computered random number table method.In the observation group,there were 20 males and 13 females,aged(65.11±0.22)years.In the control group,there were 22 males and 10 females,aged(65.14±0.16)years.The patients in the two groups were treated with three-lumen and two-balloon catheter,and the patients in the observation group were assisted by somatostatin needle.The success rates of hemostasis at different time points after treatment,gastrointestinal hormones and hemodynamic indexes before and after treatment,clinical indexes after treatment,and occurrence of adverse reactions were compared between the two groups.χ^(2) test and independent sample t test were used.Results Under different treatment regimens,the success rates of hemostasis in the observation group 8,12,and 24 h after treatment[33.33%(11/33),60.61%(20/33),and 90.91%(30/33)]were higher than those in the control group[18.75%(6/32),43.75%(14/32),and 68.75%(22/32)],with statistically significant differences(all P<0.05).Before treatment,there were no statistically significant differences in the levels of growth hormone(SS),gastrin(GAS),and motilin(MLT)between the two groups(all P>0.05).After treatment,the levels of SS[(15.24±0.12)ng/L],GAS[(80.26±0.32)ng/L],and MLT[(211.32±5.16)ng/L]in the observation group were lower than those in the control group[(15.63±0.82)ng/L,(80.65±0.88)ng/L,and(218.41±5.32)ng/L],with statistically significant differences(all P<0.05).Before treatment,there were no statistically significant differences in the central venous pressure(CVP)and portal venous pressure(PVP)between the two groups(both P>0.05).After treatment,the CVP[(9.15±0.27)mmHg(1 mmHg=0.133 kPa)]and PVP[(25.14±0.27)mmHg]in the observation group were lower than those in the control group[(9.58±0.82)mmHg and(25.56±0.85)mmHg],with statistically significant differences(both P<0.05).After treatment,the hemostasis time[(20.25±0.33)min],blood transfusion volume[(266.42±10.45)ml],and rebleeding rate[6.06%(2/33)]in the observation group were all lower than those in the control group[(20.77±0.82)min,(275.33±10.28)ml,and 18.75%(6/32)],with statistically significant differences(all P<0.05).After treatment,there was no statistically significant difference in the incidence of adverse reactions between the observation group[12.12%(4/33)]and the control group[9.38%(3/32)](P>0.05).Conclusions In the treatment of liver cirrhosis complicated with EGVB patients by three-lumen and two-balloon catheter,the combined application of somatostatin needle can enhance the hemostatic effect,which has positive significance in further inhibiting the gastrointestinal hormones,improving the hemodynamics,shortening the hemostatic time,reducing the blood transfusion volume,and reducing the risk of rebleeding.The combined application of somatostatin needle does not significantly enhance the risk of adverse reactions,with high safety.