摘要
目的:探讨急诊内镜治疗前使用特利加压素对食管胃静脉曲张出血的影响。方法:回顾性选取2017年6月-2021年11月南通市第三人民医院急诊收治的351例急性食管胃静脉曲张出血患者。使用特利加压素的患者201例,使用奥曲肽的患者150例,通过药物治疗6~12 h后,其中有50例患者仍有活动性出血,予以急诊内镜下治疗。根据内镜治疗前不同使用药物将其分为特利加压素组(n=22)和奥曲肽组(n=28)。两组均给予基础治疗,奥曲肽组内镜治疗前给予奥曲肽,特利加压素组内镜治疗前给予特利加压素。比较两种药物急诊内镜治疗情况。比较两组出血表现、胃内积血情况及视野清晰度、止血成功及再出血率、相关指标。结果:使用奥曲肽急诊内镜治疗占比为18.7%(28/150),使用特利加压素急诊内镜治疗占比为10.9%(22/201)。使用特利加压素的患者急诊内镜下治疗占比更低(χ^(2)=4.192,P<0.05)。奥曲肽组喷射样出血和渗血占比为53.6%(15/28)高于特利加压素组的45.5%(10/22),两组比较差异无统计学意义(χ^(2)=0.325,P=0.569)。奥曲肽组出血部位未明确占比为14.3%(4/28),高于特利加压素组的4.5%(1/22),但两组比较差异无统计学意义(χ^(2)=1.299,P=0.254)。特利加压素组胃内积血情况优于奥曲肽组,清晰占比高于奥曲肽组(P<0.05)。两组止血成功率比较差异无统计学意义(P>0.05),两组均未出现再出血。特利加压素组腹水加重率低于奥曲肽组,肌酐下降值大于奥曲肽组(P<0.05)。结论:特利加压素治疗食管胃静脉曲张出血能减少内镜治疗,减少胃内积血量,改善内镜视野和肾功能,减少腹水的发生。
Objective:To explore the effect of the use of Terlipressin before emergency endoscopic treatment on esophageal and gastric variceal bleeding.Method:A total of 351 patients with acute esophageal and gastric variceal bleeding admitted to the Emergency Department of the Third People’s Hospital of Nantong from June 2017 to November 2021 were retrospectively selected.A total of 201 patients used the Terlipressin and 150 patients used the Octreotide.After 6-12 hours of drug treatment,50 patients still had active bleeding and were treated under emergency endoscopy.They were divided into Terlipressin group (n=22) and Octreotide group (n=28) according to the different drugs used before endoscopic treatment.Both groups were given basic treatment,Octreotide group was given Octreotide before endoscopic treatment,and Terlipressin group was given Terlipressin before endoscopic treatment.The emergency endoscopic treatment condition was compared between the two drugs.The bleeding manifestations,blood accumulation condition in stomach,visual field clarity,hemostasis success and rebleeding rate,and related indicators were compared between the two groups.Result:Emergency endoscopic treatment using Octreotide accounted for 18.7% (28/150),and emergency endoscopic treatment using Terlipressin accounted for 10.9% (22/201).The proportion of emergency endoscopic treatment was lower in patients who used Terlipressin (χ^(2)=4.192,P<0.05).The proportion of jet like bleeding and oozing blood in Octreotide group was 53.6% (15/28),which was higher than 45.5% (10/22) in Terlipressin group,there was no significant difference between the two groups (χ^(2)=0.325,P=0.569).The proportion of undetermined bleeding site in Octreotide group was 14.3% (4/28),which was higher than 4.5% (1/22) in Terlipressin group,but there was no significant difference between the two groups (χ^(2)=1.299,P=0.254).The blood accumulation condition in the stomach of Terlipressin group was better than that of Octreotide group,and the proportion of clear in Terlipressin group was higher than that in Octreotide group (P<0.05).There was no significant difference in the success rate of hemostasis between the two groups (P>0.05),and no rebleeding occurred in both groups.The ascites exacerbation rate in Terlipressin group was lower than that in Octreotide group,and the decrease value of creatinine was greater than that in Octreotide group (P<0.05).Conclusion:Terlipressin in the treatment of esophageal and gastric variceal bleeding can reduce endoscopic treatment,reduce gastric blood accumulation volume,improve endoscopic visual field and renal function,reduce the occurence of ascites.
作者
陈建
卞兆连
罗蕾蕾
邵建国
CHEN Jian;BIAN Zhaolian;LUO Leilei;SHAO Jianguo(The Third People’s Hospital of Nantong,Nantong 226000,China)
出处
《中外医学研究》
2022年第29期106-110,共5页
CHINESE AND FOREIGN MEDICAL RESEARCH
关键词
急诊内镜
食管胃静脉曲张
出血
特利加压素
奥曲肽
Emergency endoscopy
Esophageal and gastric varices
Bleeding
Terlipressin
Octreotide
