奥曲肽治疗门静脉高压性上消化道出血
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[摘要]目的 观察奥曲肽治疗门静脉高压性上消化道出血的临床疗效。 方法 选择我院确诊的门静脉高压性上消化道出血患者90例， 随机分为治疗组53例和对照组37例。治疗组应用奥曲肽0.1 mg加入生理盐水20 mL静脉注射后，奥曲肽0.3 mg加入5%葡萄糖60 mL或生理盐水60 mL中，5mL /h微量泵持续泵入，患者出血停止后减量维持24～48 h；对照组给予垂体后叶素0.2 μg/min、硝酸甘油50 μg/min持续微量泵入，观察出血停止后减量维持24～48 h。结果 治疗组24 h出血停止35例，72 h出血停止16例，总有效率96%；对照组24 h出血停止19例，72 h出血停止11例，总有效率81%，治疗组总有效率明显优于对照组，差异有统计学意义（P < 0.05）。 结论 奥曲肽对门静脉高压性上消化道出血疗效显著。
[关键词] 奥曲肽；门静脉高压；上消化道出血
[中图分类号] R657.34 [文献标识码] B [文章编号] 1673—9701（2012）26—0144—02
Octreotide in the treatment of portal hypertension with upper gastrointestinal bleeding
ZHANG Yuwen ZHANG Songlin
Department of Gastroenterology，the Forth People's Hospital of Shangqiu City in Henan Province，Shangqiu 476000，China
[Abstract] Objective To evaluate the effect of octreotide in the treatment of portal hypertension with upper gastrointestinal bleeding. Methods Ninty cases were randomly divided into two groups：the treatment group with 53 cases and control group with 37 cases. Treatment group was first given an intravenous injection with 0.1 mg octreotide in 20 mL NS ，then pumped another 0.3 mg octreotide in 60 mL 5% Glucose solution or 60 mL NS by consecutive intravenous infusion with the speed of 5 mL per hour ，reduction was maintained for 24 to 48 hours after stopping bleeding， while control group was consecutive pumped with Neurohypophyseal Hormones and Nitroglycerin with the speed of 0.2/min and 50g/min seperately， reduction was maintained for 24 to 48 hours after stopping bleeding. Results 35 cases stopped bleeding within 24 hours， and 16 cases within 72 hours in treatment group.The total effective rate was 96%. 19 cases stopped bleeding within 24 hours and 11 cases within 72 hours in control group， the total effective rate was 81%. Statistically significant differences（P < 0.05）were found between two groups. Conclusion Octreotide is an effective treatment for portal hypertension with upper gastrointestinal bleeding
[Key words]Octreotide；Portal hypertension；Hemorrhage of upper digesive tract
上消化道出血是内科常见的急危重症，是门静脉高压最主要并发症，病情进展快，是引起出血性休克导致患者死亡的重要原因。门静脉高压患者发生上消化道出血的主要原因是食管胃底静脉曲张破裂出血，其次是门静脉高压性胃病出血，此外还有合并消化性溃疡等胃部疾病。一般病情凶险，约50%表现大出血，再出血率、死亡率较高，应用迅速有效的止血药物，尽快止血是抢救成功的关键。目前临床常用治疗方法很多，药物止血治疗仍是最方便、快捷、有效的方法，是一种不可或缺的重要措施。对药物治疗无效者可进一步采取内镜下应用止血药物，或有条件行硬化剂注射及套扎治疗。近5年来我们应用奥曲肽治疗门脉高压性急性上消化道中、重度出血，观察到明显的临床疗效，现报道如下。
1 资料与方法
1.1 一般资料
选取2005年9月～2010年9月我院收治的90例上消化道出血患者。其中男61例，女29例，年龄38～79岁，平均55.3岁。所有患者均有门静脉高压，临床表现脾功能亢进73例，腹水26例，有条件患者均行胃镜检查，不耐受胃镜或拒绝胃镜检查的行上消化道造影检查，结合实验室检查，确诊为门脉高压性上消化道出血。其中肝炎后肝硬化致门脉高压72例，原发性胆汁肝硬化3例，酒精性肝硬化5例，肝静脉阻塞3例，肝硬化合并肝癌5例，不明原因门脉高压2例。临床表现均有呕血和黑便。将患者随机分为治疗组53例和对照组37例。