生长抑素联合泮托拉唑治疗肝硬化上消化道大出血的疗效观察(1)
[摘要] 目的：观察生长抑素联合泮托拉唑在治疗肝硬化并发上消化道大出血止血治疗中的疗效。方法：随机将136例患者分为治疗组(n=68)和对照组(n=68)，治疗组应用生长抑素联合泮托拉唑治疗，先应用生长抑素250 μg静脉推注，然后以250 μg/h的速度持续微量泵滴入，维持48～72 h；泮托拉唑40mg加入生理盐水100 ml中静脉滴注，2次/d，维持48～72 h。对照组单用生长抑素治疗，先生长抑素250 μg静脉推注，然后250 μg/h持续微量泵注射，维持48～72 h，观察各组治疗效果。结果：治疗组治疗总有效率为97.06%，高于对照组的85.30%，差异有统计学意义(P<0.05)。结论：生长抑素联合泮托拉唑是治疗肝硬化上消化道大出血的有效措施之一，疗效优于单用生长抑素的止血效果，且副作用小，值得临床推广，更适合基层医院临床应用。
[关键词] 生长抑素；泮托拉唑；肝硬化；上消化道大出血
[中图分类号] R657.3 [文献标识码] B [文章编号] 1673-7210(2011)07(a)-143-02
, 百拇医药
Clinical observation of Somatostation combined Pantoprazole in the treatment of liver cirrhosis with upper gastrointestinal massive hemorrhage
DU Jianxin1, JIANG Jinhua2, LI Ying1, LU Hong1
1.The Second People's Hospital of Pingdingshan City, He'nan Province, Pingdingshan 467000, China; 2.Disease and Prevention Center of Pingdingshan City, He'nan Province, Pingdingshan 467000, China
[Abstract] Objective: To observe the efficacy of Somatostation combined Pantoprazole in the treatment of liver cirrhosis with upper gastrointestinal massive hemorrhage. Methods: 136 patients were divided into the treatment group (n=68) and the control group (n=68). The treatment group was treated with Somatostation and Pantoprazole, first intravenous bolus injection of Somatostation 250 μg/h, then by 250 μg/h with the micro-pump to drip into, maintains 48-72 h, Pantoprazole (40 mg) were added to 100 ml NS, with intravenous drip, 2 times/d. The control group was treated with Somatostation, first intravenous bolus injection of Somatostation 250 μg/h, then by 250 μg/h with the micro-pump to drip into, maintains 48-72 h. The treatment results in the two groups were observed. Results: The total effective rate of the treatment group was 97.06%, which was higher than the control group of 85.30%, there was a significant difference (P<0.05). Conclusion: Combination of Somatostation and Pantoprazole is one of the effective actions to treat the upper gastrointestinal massive hemorrhage, the efficacy of hemostatic is better than using Somatostation alone, and the side reaction is small, which is worthy of being recommended in clinical promotion and more suitable for basic unit hospital.
, http://www.100md.com
[Key words] Somatostation; Pantoprazole; Liver cirrhosis; Upper gastrointestinal massice hemorrhage
上消化道出血是指屈氏韧带以上的食管、胃、十二指肠和胰胆等病变引起的出血，是肝硬化最常见并发症之一，多以突然大呕血、解黑便就诊，易引起失血性休克或诱发肝性脑病，发病急，症状重，治疗困难，病死率极高[1]。出血病因除了食管胃底静脉曲张破裂外，部分由消化性溃疡、门脉高压性胃病或急性胃黏膜糜烂所致。临床除采取急救措施及对症治疗外，主要以降门脉压力、收缩内脏血管、抑制胃酸分泌为主。本文采用生长抑素联合泮托拉唑治疗肝硬化并发上消化道出血136例，疗效显著，现报道如下：
1 资料与方法
1.1 一般资料
将我院2006年7月～2010年11月收治的肝硬化并发上消化道大出血患者136例，随机分为治疗组与对照组，各68例。其中，男112例，女24例；年龄31～78岁，平均(51.5±4.8)岁；其中肝炎后肝硬化109例，酒精性肝硬化24例，其他3例。平均出血次数3.2次，出血量<500 ml，治疗组30例，对照组26例；出血量500～1 000 ml，治疗组20例，对照组24例；出血量>1 000 ml，治疗组18例，对照组18例。肝功能按Child-pugh分级，肝功能A级，治疗组24例，对照组20例；肝功能B级，治疗组36例，对照组38例；肝功C级，治疗组8例，对照组10例。两组患者一般资料、性别、年龄、出血情况、肝功能分级差异均无统计学意义(P>0.05)，具有可比性。
, http://www.100md.com
1.2 诊断标准
两组患者入院前24 h均有呕血、黑便史，根据肝硬化及门脉高压病史、临床表现、超声检查、胃镜检查均确诊为肝硬化并发上消化道大出血[2]。
1.3 治疗方法
两组均采用常规禁食、吸氧、扩容、输血、保肝以及预防性应用抗生素等基础治疗。治疗组应用生长抑素针剂首剂250 μg静脉缓注，继以250 μg/h加入微量泵持续泵入，维持48 h～72 h；泮托拉唑钠针40 mg加入生理盐水100 ml静脉滴注，2次/d，持续48～72 h。对照组单用生长抑素治疗，用法同治疗组。治疗期间严密监测两组患者生命体征、血尿粪常规、肝肾功能、出血量、尿量、出凝血时间以及药物反应等。, 百拇医药(杜建新 蒋锦华 李樱 芦红)
[关键词] 生长抑素；泮托拉唑；肝硬化；上消化道大出血
[中图分类号] R657.3 [文献标识码] B [文章编号] 1673-7210(2011)07(a)-143-02
, 百拇医药
Clinical observation of Somatostation combined Pantoprazole in the treatment of liver cirrhosis with upper gastrointestinal massive hemorrhage
DU Jianxin1, JIANG Jinhua2, LI Ying1, LU Hong1
1.The Second People's Hospital of Pingdingshan City, He'nan Province, Pingdingshan 467000, China; 2.Disease and Prevention Center of Pingdingshan City, He'nan Province, Pingdingshan 467000, China
[Abstract] Objective: To observe the efficacy of Somatostation combined Pantoprazole in the treatment of liver cirrhosis with upper gastrointestinal massive hemorrhage. Methods: 136 patients were divided into the treatment group (n=68) and the control group (n=68). The treatment group was treated with Somatostation and Pantoprazole, first intravenous bolus injection of Somatostation 250 μg/h, then by 250 μg/h with the micro-pump to drip into, maintains 48-72 h, Pantoprazole (40 mg) were added to 100 ml NS, with intravenous drip, 2 times/d. The control group was treated with Somatostation, first intravenous bolus injection of Somatostation 250 μg/h, then by 250 μg/h with the micro-pump to drip into, maintains 48-72 h. The treatment results in the two groups were observed. Results: The total effective rate of the treatment group was 97.06%, which was higher than the control group of 85.30%, there was a significant difference (P<0.05). Conclusion: Combination of Somatostation and Pantoprazole is one of the effective actions to treat the upper gastrointestinal massive hemorrhage, the efficacy of hemostatic is better than using Somatostation alone, and the side reaction is small, which is worthy of being recommended in clinical promotion and more suitable for basic unit hospital.
, http://www.100md.com
[Key words] Somatostation; Pantoprazole; Liver cirrhosis; Upper gastrointestinal massice hemorrhage
上消化道出血是指屈氏韧带以上的食管、胃、十二指肠和胰胆等病变引起的出血，是肝硬化最常见并发症之一，多以突然大呕血、解黑便就诊，易引起失血性休克或诱发肝性脑病，发病急，症状重，治疗困难，病死率极高[1]。出血病因除了食管胃底静脉曲张破裂外，部分由消化性溃疡、门脉高压性胃病或急性胃黏膜糜烂所致。临床除采取急救措施及对症治疗外，主要以降门脉压力、收缩内脏血管、抑制胃酸分泌为主。本文采用生长抑素联合泮托拉唑治疗肝硬化并发上消化道出血136例，疗效显著，现报道如下：
1 资料与方法
1.1 一般资料
将我院2006年7月～2010年11月收治的肝硬化并发上消化道大出血患者136例，随机分为治疗组与对照组，各68例。其中，男112例，女24例；年龄31～78岁，平均(51.5±4.8)岁；其中肝炎后肝硬化109例，酒精性肝硬化24例，其他3例。平均出血次数3.2次，出血量<500 ml，治疗组30例，对照组26例；出血量500～1 000 ml，治疗组20例，对照组24例；出血量>1 000 ml，治疗组18例，对照组18例。肝功能按Child-pugh分级，肝功能A级，治疗组24例，对照组20例；肝功能B级，治疗组36例，对照组38例；肝功C级，治疗组8例，对照组10例。两组患者一般资料、性别、年龄、出血情况、肝功能分级差异均无统计学意义(P>0.05)，具有可比性。
, http://www.100md.com
1.2 诊断标准
两组患者入院前24 h均有呕血、黑便史，根据肝硬化及门脉高压病史、临床表现、超声检查、胃镜检查均确诊为肝硬化并发上消化道大出血[2]。
1.3 治疗方法
两组均采用常规禁食、吸氧、扩容、输血、保肝以及预防性应用抗生素等基础治疗。治疗组应用生长抑素针剂首剂250 μg静脉缓注，继以250 μg/h加入微量泵持续泵入，维持48 h～72 h；泮托拉唑钠针40 mg加入生理盐水100 ml静脉滴注，2次/d，持续48～72 h。对照组单用生长抑素治疗，用法同治疗组。治疗期间严密监测两组患者生命体征、血尿粪常规、肝肾功能、出血量、尿量、出凝血时间以及药物反应等。, 百拇医药(杜建新 蒋锦华 李樱 芦红)