蛇毒血凝酶单独与联合生长抑素在急性上消化道出血患者中的应用

Application of snake venom hemocoagulase alone and somatostatin in patients with acute upper gastrointestinal hemorrhage

目的观察蛇毒血凝酶单独与联合生长抑素在急性上消化道出血患者中的应用效果。方法选择2019年1月至2023年11月在我院治疗的急性上消化道出血患者64例为研究对象,随机分为蛇毒血凝酶组和蛇毒血凝酶联合生长抑素组(以下称为联合组),每组32例。两组患者均给予常规药物治疗,蛇毒血凝酶组在常规药物治疗上给予蛇毒血凝酶治疗,联合组在常规药物治疗上给予蛇毒血凝酶与生长抑素联合治疗。比较两组患者的临床疗效和临床指标(止血时间、血压稳定时间、隐血试验转阴时间),并测定治疗前后的凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体(DD)、纤维原蛋白(FIB)]水平,并统计不良反应发生率。结果两组患者的临床疗效比较,联合组明显高于蛇毒血凝酶组,差异有统计学意义(P<0.05)。两组患者的临床指标比较,联用组在止血时间、血压稳定时间、隐血试验转阴时间方面均明显短于蛇毒血凝酶组,差异均有统计学意义(均P<0.05)。治疗后,两组患者凝血功能指标中的PT、APTT水平均明显低于治疗前,FIB和DD水平均明显高于治疗前,差异均有统计学意义(均P<0.05);治疗后,两组患者的凝血功能指标比较,联合组的PT、APTT水平均明显低于蛇毒血凝酶组,FIB和DD水平均明显高于蛇毒血凝酶组,差异均有统计学意义(均P<0.05)。两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论蛇毒血凝酶与生长抑素联合应用对急性上消化道出血患者的治疗效果较单独使用蛇毒血凝酶更佳,能快速止血,改善凝血功能,且安全性良好,值得临床应用。

Objective To observe the effect of snake venom hemocoagulase alone and somatostatin in patients with acute upper gastrointestinal hemorrhage.Methods A total of 64 patients with acute upper gastrointestinal hemorrhage treated in our hospital from January 2019 to November 2023 were selected as study subjects and randomly divided into snake venom hemocoagulase group and snake venom hemocoagulase combined with somatostatin group(hereinafter referred to as the hemocoagulase group and combination group),with 32 cases in each group.Both groups were given conventional drug therapy,the hemocoagulase group was given snake venom hemocoagulase therapy in addition to conventional drug therapy,and the combination group was given snake venom hemocoagulase and somatostatin combined therapy in addition to conventional drug therapy.The clinical efficacy and clinical indexes[hemostatic time,blood pressure stabilization time,occult blood test negative time]of the two groups were compared,and the coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT),D dimer(DD),fibrinogen(FIB)]levels before and after treatment were measured.The incidence of adverse reactions was statistic measured.Results The clinical efficacy of combination group was significantly higher than that of hemocoagulase group,and the difference was statistically significant(P<0.05).Compared with the clinical indexes of the two groups,the time of hemostasis,the time of blood pressure stabilization and the time of negative transition in occult blood test in the combined treatment group were significantly shorter than those in the hemocoagulase group,with statistical significance(all P<0.05).After treatment,the levels of PT and APTT in coagulation function indexes in 2 groups were significantly lower than before treatment,and the levels of FIB and DD were significantly higher than before treatment,with statistical significance(all P<0.05).After treatment,compared with coagulation function indexes of 2 groups,the levels of PT and APTT in combination group were significantly lower than those in hemocoagulase group,and the levels of FIB and DD were significantly higher than those in hemocoagulase group,with statistical significance(all P<0.05).There was no significant difference in the incidence of adverse reactions between 2 groups(P>0.05).Conclusion The treatment effect of snake venom hemocoagulase combined with somatostatin is better than that of snake venom hemocoagulase alone in patients with acute upper gastrointestinal hemorrhage.It can stop bleeding quickly and improve coagulation function,and it is safe and worthy of clinical application.