摘要
目的:验证奥曲肽?垂体后叶素和奥美拉唑治疗肝硬化门脉高压性胃病急性出血的临床疗效.方法:将68例经胃镜证实为肝硬化门脉高压性胃病急性出血的患者随机分为3组,分别给予奥曲肽(首剂100μg静推,以25μg·h-1持续静滴24h,再减至20μg·h-1,持续静滴24h,共48h)?垂体后叶素(最初10min内,静滴1U·min-1,其后以0.1U·min-1维持静滴,共48h)和奥美拉唑(40mg静推,每12h一次,共48h),通过胃管抽吸胃内容物观察止血情况,进行对照研究.记录患者的输血量,药物的不良反应,并在治疗后2wk内复查胃镜.结果:奥曲肽组48h的完全止血率达100%,显著高于垂体后叶素组(64%)和奥美拉唑组(59%);奥曲肽组24h输血量显著低于垂体后叶素组和奥美拉唑组;垂体后叶素组的不良反应发生率显著高于奥曲肽组和奥美拉唑组;垂体后叶素组和奥美拉唑组在48h内未止血的17例,应用垂体后叶素+奥美拉唑治疗,可显著提高止血率;47例患者治疗2wk后胃镜复查显示:黏膜糜烂?浅溃疡和红斑征基本消失,但“猩红热”样疹或蛇皮样改变无明显变化.结论:奥曲肽对门脉高压性胃病急性出血具有快速?高效及安全的优点;垂体后叶素联合奥美拉唑能显著提高止血率;治疗后门脉高压性胃病的黏膜病变有所改善.
AIM:To assess and compare the clinical effectiveness of octr eotide, vasopressin, and omeprazole in the treatment of acute bleeding in patien ts with portal hypertensive gastropathy. METHODS:Sixty eight patients with portal hypertensive gastropath y were randomized into octreotide(100μg was given as a bolus in jection, followed by a continuous intravenous infusion at a rate of 25μ g·h-1 for the first 24 hours, and the dose was reduced to 20μg·h-1 for the second 24 hours,total 48 hours), vasopressin (given as an intravenous infusion at a rate of 1 U·min-1 for the first 1 0 minutes, followed by a continuous infusion at a rate of 0.1 U·min-1 fo r 48 hours), and omeprazole(an initial bolus of 40 mg was injected, and the same dose was repeated every 12 hours for a total of 48 hours) groups,respectively.B leeding was monitored by observing the contents of nasogastric tube.Blood transf usion requirements and side effects of drugs were recorded.Repeat endoscopies we re scheduled 2 wk after treatment. RESULTS:Complete bleeding control after 48 h of drug infusion was achieved in all patients receiving octreotide(100%), 1422 patients receiving vasopressin(64%), and 1322 patients receiving omeprazole(59%).Compared with vas opressin and omeprazole groups,within 24 hours of drug infusion, octreotide requ ired much less time and significantly less blood transfusion to control bleeding .Patients receiving vasopressin experienced more side effects than those receivi ng octreotide and omeprazole. In the 17 patients whose bleeding was not controll ed with 48 hours by either vasopressin or omeprazole,complete bleeding control w as achieved by combined use of these two agents.Follow up endoscopy showed drama tic improvement in gastric mucosal erosions,superficial ulceration and erythema. However,the scarlatina rash and snake-skin lesion did not changed. CONCLUSION:Octreotide appeared to be more effective in controll ing acute bleeding in patients with portal hypertensive gastropathy, with signifi cantly rapid action, smaller transfusion requirements,and minor side effects.Sim ultaneous administration of vasopressin and omeprazole seemed to have additive e ffects.
出处
《世界华人消化杂志》
CAS
2002年第2期197-200,共4页
World Chinese Journal of Digestology
