【摘要】 [目的]探讨在食管静脉曲张出血救治中早期应用生长抑素48h后联合延迟内镜下套扎治疗的有效性、合理性和安全性。[方法]选择食管静脉曲张出血患者60例,按2∶1比例随机分成A组与B组。A组:40例给予生长抑素(思他宁)250μg/h微量泵持续静脉注射48h,出血基本停止,病情稳定后行内镜下套扎食管曲张静脉;B组:20例给予血管加压素0.2~0.4U/min,静脉持续滴注,加用硝酸甘油,开始先以10μg/min,持续静脉滴注,每10min根据血压调整1次,每次增加5~10μg,收缩压达90~100mmHg(1mmHg=0.133kPa)为度;生命体征平稳,24h内紧急内镜下套扎止血治疗。2组治疗观察时间均为7d;观察指标:2组治疗24h、48h止血率,治疗5d再出血率,治疗的不良反应。[结果]A组、B组24h止血率分别为60%、20%,2组24h止血率比较差异有统计学意义(P<0.01)。A组、B组48h止血率分别为95%、70%,A组48h止血率明显高于B组(P<0.05)。A组、B组5d再出血率分别为7.5%、40.0%,A组再出血率明显低于B组(P<0.01)。B组治疗过程中患者几乎都有不良反应,程度较重,明显高于A组。[结论]早期应用生长抑素联合延迟内镜治疗可提高止血效果和减少再出血率;尽早使用生长抑素可提高内镜套扎治疗的有效性和安全性,患者不良反应少,较紧急内镜治疗更加合理。更多还原

【Abstract】 [Objective]This trial was to evaluate the efficacy,rationality and safety of the combination of somatostatin(Stilamin)infusion in early stage and endoscopic variceal ligation(EVL)in late stage in patients with acute esophageal variceal bleeding.[Methods]Sixty cases with esophageal variceal bleeding,were randomized to two groups(A and B group)according to 2∶1rate.The treatment time was 7d.End points were initial hemostasis,very early rebleeding rate,and adverse events.In group A,forty patients with esophageal variceal bleeding were treated with Stilamin 250μg/h continuously infusion for 48 h.After the bleeding stopped and condition was stable,endoscopic ligation of esophageal varices was performed.In group B:twenty patients with esophageal variceal bleeding were treated with vasopressin 0.2-0.4 U/min,intravenous infusion,plus nitroglycerin,according to the blood pressure to adjust the dose.Emergency endoscopic ligation was performed within 24 h.If the rebleeding after endoscopic ligation or serious adverse reactions(palpitations,chest pain,angina pectoris,severe abdominal pain),Stilamin 250μg/h continuous intravenous infusion was chosen until the bleeding stops.[Results]Hemostasis in A group within 24 hwas recorded in24cases(60%),the number of stopping bleeding in 48 hours was recorded in 38cases(95%);hemostasis in B group in 24 hwas recorded in 4cases(20%),rebleeding within 48 hwas recorded in 14cases(70%).Group A hemostatic rate was higher than the group B(P<0.01).During the treatment,the adverse reactions in patients in group B was severe,and the rate was significantly higher than that in group A.[Conclusion]somatostatin infusion in early stage combined with EVL can improve the hemostatic effect and reduce the rate of rebleeding.The therapy is effective and safe in the treatment of patients with less adverse reaction.The combination treatment is more reasonable than emergency endoscopic treatment.更多还原