肝硬化食管胃底静脉曲张破裂出血应用生长抑素联合奥美拉唑的治疗效果

目的了解肝硬化食管胃底静脉曲张破裂出血应用生长抑素联合奥美拉唑的治疗效果。方法选取本院2013年10月~2016年4月收治的108例肝硬化食管胃底静脉曲张破裂出血患者,采用数字随机法,将患者分为观察组和对照组各54例,对照组给予奥美拉唑治疗,剂量为60mg(静脉注射),2次/d,疗程为3d。观察组在对照组基础上给予生长抑素治疗,剂量为3mg+0.9%的生理盐水50ml静脉泵入Q12h,疗程为3d。观察两组患者临床有效率、止血时间及不良反应。结果观察组临床有效率为(52/54)96.30%,明显高于对照组的(43/54)79.63%,差异有统计学意义(P<0.05);观察组的止血时间为(24.73±8.35)h,明显少于对照组的(48.24±9.02)h,比较差异有统计学意义(P<0.05);观察组的不良反应发生率为(2/54)3.70%,明显低于对照组的(10/54)18.52%,比较差异有统计学意义(P<0.05)。结论肝硬化食管胃底静脉曲张破裂出血应用生长抑素联合奥美拉唑的治疗效果显著,能有效减少患者的止血时间,降低不良反应发生率,为肝硬化食管胃底静脉曲张破裂出血制定治疗方案提供参考依据。     

生长抑素联合内镜下食管胃底静脉曲张套扎及硬化治疗肝硬化合并食管胃底静脉曲张破裂出血研究

目的：探讨肝硬化合并食管胃底静脉曲张破裂出血给予生长抑素联合内镜下食管胃底静脉曲张套扎及硬化治疗的临床价值。方法：选取2019年5月~2020年6月收治的75例肝硬化合并食管胃底静脉曲张破裂出血患者,根据治疗方法不同分为观察组39例和对照组36例。对照组给予生长抑素治疗,观察组在此基础上联合内镜下食管胃底静脉曲张套扎及硬化治疗。比较两组临床疗效、止血情况和不良反应发生情况。结果：观察组临床总有效率、止血成功率高于对照组,再出血率低于对照组,止血时间短于对照组（P＜0.05）;两组并发症发生率比较无显著差异（P＞0.05）。结论：对肝硬化合并食管胃底静脉曲张破裂出血患者采取生长抑素联合内镜下食管胃底静脉曲张套扎及硬化治疗的效果更佳,可有效提高止血成功率,降低再出血率,缩短止血时间,且安全性好。     

生长抑素垂体后叶素及奥美拉唑三联治疗肝硬化食管胃底静脉曲张破裂出血疗效观察

目的 评价生长抑素、垂体后叶素及奥美拉唑三联治疗肝硬化食管胃底静脉曲张破裂出血的疗效和不良反应.方法 将157例肝硬化并食管胃底静脉曲张破裂出血患者随机分为三组:生长抑素、垂体后叶素及奥美拉唑三联(A)组77例,单用生长抑素(B)组42例及单用垂体后叶素(C)组38例,记录并比较三组药物治疗上消化道出血的疗效及不良反应.结果 A组治疗食管胃底静脉曲张破裂出血有效率93%(72/77),明显高于B组78%(33/42)和C组55%(21/38),P均＜0.05.A组药物不良反应发生率为22%,明显低于C组(44%,P＜0.05),而与B组差异无统计学意义(14%,P＞0.05).结论 生长抑素、垂体后叶素及奥美拉唑三联治疗肝硬化食管胃底静脉曲张破裂出血安全、有效.     

奥曲肽联合奥美拉唑治疗食管胃底静脉曲张出血28例的疗效

食管胃底静脉曲张出血是肝硬化严重并发症，来势凶，出血量大，死亡率高达50％。生长抑素及其类似药物被广泛用于肝硬化食管胃底静脉曲张出血，并已取得较为满意的效果。2005年6月～2007年6月，笔者应用奥曲肽联合奥美拉唑治疗食管胃底静脉曲张出血28例，取得满意疗效，报告如下。     

奥曲肽治疗肝硬化食管胃底静脉曲张破裂出血35例疗效

目的：评价奥曲肽治疗肝硬化食管胃底静脉曲张破裂出血的疗效。方法：将66例肝硬化食管胃底静脉曲张破裂出血分为两组，奥曲肽组35例用奥曲肽100μg静注，继以25μg／h持续静脉滴注72h；垂体后叶素组31例用垂体后叶素10u静注后继以0．2U／min维持静脉滴注72h。结果。治疗组有效30例，无效5例，再出血3例，有效率为85．71％；对照组有效13例，无效18例，再出血5例，再出血3例，有效率41.93％，两组有效率比较差异有显著性（P〈0．01），且治疗组不良反应显著降低。结论：奥曲肽能有效治疗肝硬化食管胃底静脉曲张破裂出血，疗效优于垂体后叶素。     

肝硬化并发食管胃底静脉曲张破裂出血116例

1一般资料本文总结肝硬化并发食管胃底静脉曲张破裂出血116例(占同期上消化道出血之8．63％，占上消化道大出血之49．8％。全部病例均有肝硬化的临床表现并有胃镜和／或GI等证实且排除溃疡病等所致之出血。116例中男63例，女53例。年龄28～77岁，平均55．7岁。病因中肝炎后肝硬化82例(53例并血吸虫病)；血吸虫病性肝纤维化26     

生长抑素联合奥美拉唑治疗肝硬化食管静脉曲张破裂出血的临床疗效分析

将我院2010年1月~2014年12月收治的68例肝硬化患者作为研究对象,随机分为两组,其中给予对照组垂体后叶素联合奥美拉唑治疗,而观察组则运用生长抑素联合奥美拉唑治疗,对比分析两组治疗效果。结果观察组例17例显效,14例有效,2例无效,1例死亡,治疗总有效率为91.17%;对照组10例显效,15例有效,6例无效,3例死亡,治疗总有效率为73.5%,两组临床治疗效果差异明显,具有统计学意义(P<0.05)。临床上运用生长抑素和奥美拉唑对肝硬化食管静脉曲张破裂出血患者进行联合治疗,不仅止血时间快、不良反应少,在一定程度上还能提高治疗效果,改善患者预后生活质量。     

探讨奥曲肽治疗急性肝硬化并食管-胃底静脉曲张破裂出血的疗效

肝硬化并食管-胃底静脉曲张破裂出血是上消化道出血急诊中最常见的急危重症之一[1],其病因虽明确,但病情进展快,是引起出血性休克导致病人死亡的重要原因。迅速有效的止血疗法是抢救成功的关键。我院自2000年以来采用奥曲肽(生长抑素8肽,善宁)治疗多种病因引起的急性上消化道大     

肝硬化食管胃底静脉曲张破裂出血护理体会

食管胃底静脉曲张破裂出血是肝硬化门静脉高压症最凶险的并发症之一，我科对此类患者进行止血、抑酸、补充血容量、降低门脉压预防合并症。采取心理护理、认知行为、饮食生活等健康宣教。使患者转危为安。     

生长抑素垂体后叶素联合治疗食管胃底静脉曲张破裂出血疗效观察

食管胃底静脉曲张破裂出血是肝硬化最为常见和严重的并发症，急性出血病死率平均为32％，迅速有效止血是治疗的关键。我院2005—06—2011—10对120例食管胃底静脉曲张破裂出血患者分别应用生长抑素联合垂体后叶素和单用生长抑素治疗，现将其疗效报告如下。     

肝硬化合并胃静脉曲张出血121例临床研究

目的 分析急诊内镜治疗肝硬化合并胃静脉曲张出血患者的疗效.方法 内镜下套扎、硬化和组织粘合剂栓塞等方法治疗121例肝硬化合并胃静脉曲张出血患者.结果 121例出血患者中,96例止血成功(79.3％),硬化、套扎、组织粘合剂注射的止血率分别为78.3％、50.0％和85.2％.因各种原因死亡13人,病死率为10.7％.胃镜诊治过程中未出现1例死亡.结论 肝硬化合并胃静脉曲张破裂出血,针对不同的情况采取不同的内镜下治疗,可以达到较好的治疗效果.     

Effect of somatostatin on liver blood flow and liver metabolic activity in patients with cirrhosis

In a group of 10 patients with cirrhosis, protal hypertension, and previous gastro-intestinal bleedings, hepatic plasma flow, indocyanine green clearance and intrinsic hepatic clearance were determined before and during i.v. infusion of somatostatin (7.5 micrograms/min). The same study protocol was performed in a further seven patients with cirrhosis infused with placebo. All these parameters were significantly decreased by the drug (p less than 0.05; less than 0.01; less than 0.01, respectively) mean decrease being 12, 9 and 8%, respectively, while no significant change occurred in the placebo-infused patients. These data indicate that somatostatin infused at a dose of 7.5 micrograms/min in cirrhotics provokes a slight decrease in hepatic plasma flow and in liver metabolic activity. This effect may contribute to further decrease hepatic removal of harmful substances and may increase systemic concentration of drugs metabolized by the liver.     

生长抑素联合奥美拉唑治疗重度老年上消化道出血的临床疗效

目的 观察生长抑素联合奥美拉唑治疗重度老年上消化道出血的临床疗效.方法 选取2008年3月至2013年4月在安徽省萧县人民医院消化内科住院治疗的部分重度老年上消化道出血患者共40例,按随机数字表法分为两组,奥美拉唑组20例,奥美拉唑＋生长抑素组20 例.两组患者的一般临床资料比较差异无统计学意义（P〉0.05）.结果 两组患者入院治疗72 h后,奥美拉唑＋生长抑素组收缩压、脉搏、血红蛋白恢复情况较奥美拉唑组明显好转,差异有统计学意义（P〈0.05）.结论 生长抑素联合奥美拉唑钠治疗重度老年上消化道出血具有止血迅速、失血量少等优点,值得临床推广.     

Effect of vasopressin and somatostatin on hemodynamics and blood gases in patients with liver cirrhosis

The effects of somatostatin and vasopressin on blood gases, pulmonary and systemic hemodynamics, and portal pressure assessed by the gradient between occluded and free hepatic vein pressures, were investigated in 18 patients with liver cirrhosis. In the first 10 patients, an iv bolus of 250 microgram somatostatin, followed by an infusion of 125 microgram somatostatin over 30 min, caused a sudden rise in pulmonary and systemic vascular pressures lasting 2 to 5 min and accompanied by bradycardia. There was a slight and transient increase in venous admixture (Qsp/Qt) and alveolar-arterial oxygen tension gradients (P(A-a)O2), and a transient reduction in O2 delivery (O2 del) (-11% of the baseline values) and portal pressures (-14%). In the next 8 patients, vasopressin, 0.4 U/min infused over 30 min, caused a more persistent pulmonary and systemic hypertension and bradycardia, a slight increase in P(A.a)O2 and Qsp/Qt, a reduction in O2 del (-27%) and a decrease in portal pressures (-32%). These effects were marked during the entire vasopressin infusion period. Both somatostatin and vasopressin had vasoconstrictive properties and exerted negative effects on hemodynamics and blood gases. Vasopressin appeared to be a more potent drug than somatostatin.     

不同剂量生长抑素对肝硬化伴食管胃底静脉曲张GAS、HGB、GLC的影响

目的探讨不同剂量生长抑素对肝硬化伴食管胃底静脉曲张患者胃泌素(GAS)、血红蛋白(HGB)及胰高血糖素(GLC)的影响。方法收集2018年12月至2019年12月在本院治疗的106例肝硬化伴食管胃底静脉曲张患者的临床资料,根据药物使用剂量不同分为A组(53例,标准剂量生长抑素联合普萘洛尔治疗)和B组(53例,加倍剂量生长抑素联合普萘洛尔治疗)。对比两组患者治疗后临床疗效、治疗前后GAS、HGB、GLC水平、住院指标及血流动力学指标水平,观察2组患者治疗后不良反应发生情况。结果B组总有效率(90.57%)高于A组(71.70%),差异有统计学意义(P<0.05)。与治疗前比较,两组GAS、GLC明显下降,HGB明显升高,差异有统计意义(P<0.05);治疗后B组患者GAS、GLC低于A组,HGB高于A组,差异有统计学意义(P<0.05)。A组住院时间、止血时间均长于B组,输血量高于B组,差异有统计学意义(P<0.05)。与治疗前比较,两组患者CVP、PVP均明显下降,差异具有统计学意义(P<0.05);治疗后B组患者CVP、PVP明显低于A组,差异有统计学意义(P<0.05);两组治疗前后VPV水平相近,差异无统计学意义(P>0.05)。A组患者治疗后不良反应总发生率为5.66%明显低于B组16.98%,差异有统计学意义(P<0.05)。结论加倍剂量生长抑素联合普萘洛尔治疗临床疗效好,可有效改善患者GAS、HGB、GLC水平及血流动力学指标,并缩短患者住院时间、止血时间,安全性高,临床应用价值大。     

Clinical evaluation of combined endoscopic variceal ligation and sclerotherapy of gastric varices in liver cirrhosis

BACKGROUND AND STUDY AIMS: Endoscopic injection sclerotherapy (EIS) using cyanoacrylate and balloon-occluded retrograde transvenous obliteration (B-RTO) are the main procedures used to treat gastric varices. However, neither technique is free of problems. EIS for gastric varices may cause embolism in other organs; B-RTO requires a gastrorenal shunt and may aggravate esophageal varices. We have developed a combined form of endoscopic therapy involving band ligation and sclerotherapy which is an effective and safe procedure for treating gastric varices. PATIENTS AND METHODS: Fifty-six patients with gastric varices and liver cirrhosis were treated at Almeida Memorial Hospital from June 1997 to May 2002 using the combined procedure. Each gastric varix was tightly ligated with O-rings, and 1 % polidocanol was injected into the submucosa around the ligated varix. If necessary, additional sclerotherapy was carried out after the initial treatment. RESULTS: The rate of hemostasis for variceal bleeding was 100 %, and no critical complications were noted. Complete disappearance of the gastric varices was observed endoscopically in all cases. Computed tomography showed that collateral vessels outside the gastric wall were not occluded by the treatment. Endoscopic follow-up examinations were carried out, and gastric varices recurred in seven patients (12.5 %). Only two of the patients (3.6 %) had a small amount of oozing bleeding. Additional endoscopic variceal ligation (EVL) and/or EIS were performed in these seven cases, and none of the patients died as a result of a bleeding gastric varix. CONCLUSIONS: The combined procedure was easily performed immediately after endoscopic examination, and required no special apparatus. It was found to be a safe and effective method of treating gastric varices.     

MELD评分与肝硬化食道静脉曲张破裂出血患者预后的关系

目的研究中末期肝病模型（model for end stage liver disease，MELD）分级评分对肝硬化食道静脉曲张破裂出血患者应用生长抑素联合三腔二囊管压迫止血的疗效预后分析。方法对77例应用生长抑素联合三腔二囊管压迫止血的肝硬化食道静脉曲张破裂出血患者的肝功能进行MELD评分，将这些患者按MELD评分分为4组其中MELD≤9分18例，10≤MELD≤19分32例，20≤MELD≤29分15例，MELD≥30分12例，对这些患者随访其存活率、死亡率及再出血发生率。结果4个组的存活率、死亡率、再出血发生率分别为（94．5％，84．6％，60％，33．3％）、（5．5％，15．6％，40％，58．3％）、（11％，25％，33．3％，66．7％），随着MELD评分的增高死亡率和再出血发生率均上升，差异有统计学意义。结论肝硬化食道静脉曲张破裂出血患者用生长抑素联合三腔二囊管压迫止血的死亡率和再出血发生率与MELD评分直接相关，提示MELD肝功能评分对肝硬化食道静脉曲张破裂出血的治疗有一定的指导作用。     

Effect of two different preparations of somatostatin on intra-portal pressure in patients with liver cirrhosis

Summary. Somatostatin has been found by most authors to reduce splanchnic blood flow and hepatic venous wedge pressure. High success rates in treating oesophageal varicose bleeding have been reported by some authors, while others have been unable to confirm these findings. A reason for the discrepancies might be that different preparations of somatostatin were used. Consequently, two preparations of somatostatin were administered to three cirrhotic patients as 60-min infusions at a dosage of 250 μg/h. The intra-portal pressure was measured before and during the infusions and found to be unaffected by both preparations. The findings suggest that previously demonstrated reductions in portal pressure may have been of brief duration, possibly due to vascular autoregulation.