枯草杆菌二联活菌联合生长抑素对肝硬化并发上消化道出血的治疗效果

Therapeutic Effect of Bacillus Subtilis Combined with Somatostatin on Upper Gastrointestinal Bleeding Caused by Cirrhosis

目的探讨枯草杆菌二联活菌联合生长抑素对肝硬化并发上消化道出血的治疗效果。方法选取2019年7月至2022年7月于首都医科大学附属北京顺义区医院接受治疗的350例肝硬化并发上消化道出血患者作为研究对象,按治疗方式分为联合组和常规组。常规组采取保肝、抑酸、止血等治疗,联合组在常规组基础上增加使用枯草杆菌二联活菌与生长抑素治疗。比较两组患者肝功能指标、血氨水平以及围治疗期指标变化。结果治疗后两组患者总胆红素(TBIL)、丙氨酸转氨酶(ALT)以及血氨水平较治疗前降低(P<0.05),且联合组降低程度大于常规组(P<0.05);联合组住院时间、止血时间短于常规组(P<0.05),输血量少于常规组(P<0.05),同时联合组再出血发生率(3.33%)、肝性脑病发生率(1.11%)低于常规组的再出血发生率(8.82%)、肝性脑病发生率(4.71%)(P<0.05),而两组死亡率比较差异无统计学意义(P>0.05)。结论对肝硬化并发上消化道出血患者采用枯草杆菌二联活菌与生长抑素联合治疗,能够有效止血,改善肠道功能,达到降低再出血风险,缩短出血及住院时间的目的,并且对于肝功能有一定的改善作用。

Objective To explore the therapeutic effect of Bacillus subtilis combined with somatostatin in the treatment of liver cirrhosis complicated with upper gastrointestinal bleeding.Methods 350 patients with cirrhosis complicated with upper gastrointestinal bleeding who were treated in Beijing Shunyi District Hospital affiliated to Capital Medical University from July 2019 to July 2022 were selected as the study subjects,and were divided into combined group and conventional group according to the treatment method.The routine group was treated with liver protection,acid suppression and hemostasis,while the combined group was treated with live bacillus subtilis combined with somatostatin on the basis of the routine group.The changes of liver function index,blood ammonia level and indexes during the treatment period between the two groups were compared.Results After treatment,the levels of total bilirubin(TBIL),alanine aminotransferase(ALT)and blood ammonia in two groups were decreased compared with before(P<0.05),and the reduction degree of the combined group was greater than that of the conventional group(P<0.05).The length of hospitalization,hemostasis and blood transfusion in the combined group were lower than those in the conventional group(P<0.05).Meanwhile,the incidence of rebleeding(3.33%)and hepatic encephalopathy(1.11%)in the combined group was lower than that in the conventional group(8.82%)and hepatic encephalopathy(4.71%)(P<0.05),but there was no difference in mortality between the two groups(P>0.05).Conclusion For patients with cirrhosis complicated with upper gastrointestinal bleeding,the combination of live bacillus subtilis and somatostatin can effectively stop bleeding,improve intestinal function,reduce the risk of rebleeding,shorten bleeding and hospital stay,and improve liver function to a certain extent.