生长抑素、垂体后叶素与奥美拉唑三联疗法对肝硬化伴食管—胃底静脉曲张破裂出血患者胃泌素、胰高血糖素及血流动力学影响

李超

[摘要] 目的 探討生长抑素、垂体后叶素与奥美拉唑三联疗法对肝硬化伴食管-胃底静脉曲张破裂出血（EGVB）患者胃泌素（GAS）、胰高血糖素（GLC）及血流动力学影响。 方法 选择2012年12月1日～2016年6月5日辽宁中医药大学附属医院急诊治疗的肝硬化伴EGVB患者117例，根据治疗方案分为生长抑素组、垂体后叶素组和联合组，每组各39例。生长抑素组采用生长抑素+奥美拉唑，垂体后叶素组采用垂体后叶素+奥美拉唑，联合组采用生长抑素+垂体后叶素+奥美拉唑，时间维持24～48 h。对中心静脉压、门静脉压、门静脉内径、门静脉血流速度等进行测定，采血测定GAS、GLC含量，对比两组治疗效果，同时动态监测病情变化，观察不良反应事件及处理经过。 结果 与治疗前比较，三组治疗后门静脉压（PVP）、门静脉内径（DPV）值、GAS、GLC含量均降低，差异均有统计学意义（P < 0.05）;与垂体后叶素组、生长抑素组比较，联合组治疗后PVP、DPV值较低，GAS、GLC含量较低，差异均有统计学意义（P < 0.05）;垂体后叶素组、生长抑素组改善率为74.36%、71.79%，低于联合组（92.31%）（P < 0.05）;垂体后叶素组、生长抑素组的止血时间、平均输血量及住院时间均高于联合组，差异均有统计学意义（P < 0.05）。 结论 生长抑素、垂体后叶素与奥美拉唑三联疗法可以提高肝硬化伴EGVB的止血效果，降低门脉压力、调节胃肠激素，值得广泛推广。

[关键词] 生长抑素;垂体后叶素;奥美拉唑;肝硬化;食管-胃底静脉曲张破裂出血;胃肠激素;血流动力学

[中图分类号] R5713 [文献标识码] A [文章编号] 1673-7210（2018）05（a）-0067-05

[Abstract] Objective To investigate the effects of Somatostatin， Pituitrin and Omeprazole triple therapy in the treatment of cirrhosis with hemorrhage of gastroesophageal varices in serum GAS， GLC and hemodynamics. Methods From December 1， 2012 to June 5， 2016， 117 cases of cirrhosis with hemorrhage of gastroesophageal varices were collected in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine， according to the type of treatment， were randomly divided into Somatostatin group， Pituitrin group and combined group， with 39 cases in each group， Somatostatin group was treated with Somatostatin+Omeprazole， Pituitrin group were treated with Pituitrin+Omeprazole and the combined group were treated with Somatostatin+Pituitrin+Omeprazole， and three groups were treated for 24 to 48 h. The pressure， portal venous pressure， portal vein diameter， portal vein blood flow velocity of central vein were measured， the determination of GAS and GLC in blood samples were collected and clinical effect， dynamic changes， adverse events were compared after treatment. Results Compared with that before treatment， PVP， DPV value， GAS， and GLC of the three groups after treatment decreased， the differences were statistically significant （P < 0.05）. Compared with Pituitrin group and Somatostatin group， levels of PVP and DPV were lower， GAS and GLC were lower， the differences were statistically significant （P < 0.05）. The improved rate of the Pituitrin group （74.36%） and Somatostatin group （71.79%） were lower than the combined group （92.31%）， the difference was statistically significant （P < 0.05）. The hemostatic time， average blood transfusion and hospitalization time of the Pituitrin group and the Somatostatin group were higher than the combined group （P < 0.05）. Conclusion Somatostatin， Pituitrin and Omeprazole triple therapy can improve the liver cirrhosis with esophageal and gastric variceal bleeding bleeding， reduce portal vein pressure， gastrointestinal hormone， is a kind of effective treatment.

[Key words] Somatostatin; Pituitrin; Omeprazole; Cirrhosis; Gastroesophageal variceal Bleeding; Gastrointestinal hormones; Hemodynamics

肝硬化是一种常见的严重肝病，晚期并发症较多，其中食管-胃底静脉曲张破裂出血（esophageal gastric variceal bleeding，EGVB）现象严重，病情进展迅速，一旦未得到控制，导致死亡[1]。临床处理本病的措施较多，其中内镜治疗难度大，操作技术有一定要求，首选药物是抢救肝硬化伴EGVB的重要措施。据Rockey等[2]报道抑制胃酸分泌可降低出血量，对治疗上消化道出血有益。奥美拉唑可以减少胃酸的分泌，增加胃黏膜血流量、改善胃黏膜微循环达到止血作用，成为治疗上消化道出血的药物之一。……