内镜下套扎联合奥曲肽和凝血酶治疗肝硬化并发食管胃静脉曲张出血患者疗效研究*

doi:10.3969/j.issn.1672-5069.2024.05.025

摘要/Abstract

摘要： 目的观察应用内镜下套扎(EVL)联合凝血酶散和奥曲肽治疗肝硬化并发食管胃静脉曲张破裂出血(EGVB)患者的临床疗效。方法 2021年6月～2023年6月我院收治的120例肝硬化并发EGVB患者,其中60例观察组接受EVL联合凝血酶散口服和静脉应用奥曲肽治疗,另60例对照组接受奥曲肽联合EVL治疗。药物治疗维持1 w,随访3 m。经颈静脉穿刺测量肝静脉楔压(WHVP)和肝静脉游离压(FHVP),计算肝静脉压力梯度(HVPG)。结果在治疗1 w末,观察组死亡2例,对照组死亡8例,观察组止血成功率为96.7%,显著高于对照组的86.7%(P＜0.05);在生存患者中,观察组早发再出血、迟发再出血和曲张静脉(EV)消失率分别为22.4%、17.2%和69.0%,与对照组比,均无显著性差异(分别为16.7%、13.3%和73.1%,P>0.05);治疗后,观察组HVPG为(19.1±2.6)mmHg,与对照组【(19.0±3.0)mmHg】比,无显著性差异(P>0.05);治疗前后,两组血清肝肾功能指标比较,差异无统计学意义(P>0.05)。结论采用EVL联合凝血酶散口服和奥曲肽静脉应用治疗肝硬化并发EGVB患者止血效果好,可短期消除EV,防止再出血。

关键词: 肝硬化, 食管胃静脉曲张, 内镜下静脉曲张套扎术, 凝血酶散, 奥曲肽, 治疗

Abstract: Objective This study was conducted to investigate clinical efficacy of esophageal variceal ligation (EVL) with auxiliary oral thrombin and intravenous octreotide administration in the treatment of cirrhotics with esophageal and gastric variceal bleeding (EGVB). Method 120 patients with liver cirrhosis (LC) complicated with EGVB were admitted to our hospital between June 2021 and June 2023, and among them, 60 patients in observation received EVL with auxiliary oral thrombin powder and intranenous octreotide administration, and another 60 patients in control received EVL and octreotide infusion. Medical treatment continued for 1 week, and all patients in the two groups were followed-up for three months. Wedged hepatic vein pressure (WHVP) and free hepatic vein pressure (FHVP) were measured by through jugular vein approach for calculation of hepatic vein pressure gradient (HVPG). Result At end of one week treatment, two and eight patients in the observation and control died, with successful hemostasis of 96.7% in the observation group, much higher than 86.7%(P＜0.05) in the control; among survivals, early and delayed rebleeding and disappearance of varies in the observation were 22.4%, 17.2% and 69.0%, all not significantly different compared to 16.7%, 13.3% and 73.1% (P>0.05) in the control; after treatment, HVPG in the observation was (19.1±2.6)mmHg, not significantly different compared to (19.0±3.0)mmHg in the control (P>0.05); at admission and after treatment, there were no significant differences as respect to hepatic and renal function tests in the two groups (P>0.05). Conclusion The EVL with auxiliary treatment of oral thrombin powder and intranenous octreotide maintenance in the treatment of patients with EGVB has a good efficacy, with ascertainable hemostatic effect and prevention of rebleeding.

Key words: Liver cirrhosis, Esophageal and gastric variceal bleeding, Endoscopic variceal ligation, Thrombin powder, Octreotide, Therapy

田琳, 康颖, 崔洁, 石颖鹏. 内镜下套扎联合奥曲肽和凝血酶治疗肝硬化并发食管胃静脉曲张出血患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 745-748.

Tian Lin, Kang Ying, Cui Jie, et al. Esophageal variceal ligation with auxiliary oral thrombin and intravenous octreotide administration in the treatment of cirrhotics with esophageal and gastric variceal bleeding[J]. Journal of Practical Hepatology, 2024, 27(5): 745-748.

参考文献

[1] Jakab SS, Garcia-Tsao G. Evaluation andmanagement of esophageal and gastric varices in patients with cirrhosis. Clin Liver Dis, 2020, 24(3):335-350.
[2] 中华医学会肝病学分会、消化病学分会、内镜学分会.肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 实用肝脏病杂志,2016,19(5):Ⅰ-ⅩⅤⅠ.
[3] Kulkarni AV, Arab JP, Premkumar M. Terlipressin has stood the test of time: Clinical overview in 2020 and future perspectives. Liver Int, 2020, 40(12):2888-2905.
[4] 詹致远,申洋,王凡冰.内镜下套扎术联合奥美拉唑和奥曲肽治疗肝硬化并发食管静脉曲张首次出血患者短期疗效分析.实用肝脏病杂志,2022,25(6):865-868.
[5] Gralnek IM, Camus Duboc M, Garcia-Pagan JC, et al. Endoscopic diagnosis and management of esophagogastric variceal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE)guideline. Endoscopy, 2022, 54(11):1094-1120.
[6] 中华医学会肝病学分会. 肝硬化诊治指南.实用肝脏病杂志,2019,22(6):770-792.
[7] 中华医学会肝病学分会,中华医学会消化病学分会,中华医学会内镜学分会. 肝硬化门静脉高压食管胃静脉曲张出血的防治指南. 临床肝胆病杂志,2016,32(2):203-219.
[8] 中国门静脉高压联盟(CHESS),中华医学会消化病学分会微创介入协作组. 中国肝静脉压力梯度临床应用专家共识(2023年版). 中华医学杂志,2023,103(48):3885-3895.
[9] Henry Z, Patel K, Patton H. AGAclinical practice update on management of bleeding gastric varices: expert review. Clin Gastroenterol Hepatol, 2021, 19(6):1098-1107.
[10] 林子淮,李欣明,全显跃.基于机器学习CT影像组学特征联合血清学特征模型预测高出血风险食管静脉曲张.中国CT和MRI杂志,2023,21(6):93-96.
[11] Téllez L, Guerrero A, Albillos A. Update on the diagnosis and management of portal hypertension in cirrhosis according to thebaveno VII consensus conference recommendations. Rev Esp Enferm Dig, 2022, 114(9):534-542.
[12] Garbuzenko DV, Arefyev NO. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis:an update and review of the literature. J Evid Based Med, 2020, 13(4):313-324.
[13] European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; European Association for thestudy of the liver. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol, 2018, 69(2):406-460.
[14] Mas E, Borrelli O, Broekaert I, et al. Drugs infocus: octreotide use in children with gastrointestinal disorders. J Pediatr Gastroenterol Nutr, 2022, 74(1):1-6.
[15] Jing L, Zhang Q, Chang Z, et al. Nonsurgicalsecondary prophylaxis of esophageal variceal bleeding in cirrhotic patients: a systematic review and network meta-analysis. J Clin Gastroenterol, 2021, 55(2):159-168.
[16] 杨雅娟,李静女,乔冠恩. 内镜下食管静脉曲张套扎术联合生长抑素治疗肝硬化食管静脉曲张出血的疗效. 现代消化及介入诊疗,2021,26(12):1573-1575.
[17] Scheinberg AR, Martin P, Turkeltaub JA. Terlipressin in the management of liver disease. Expert Opin Pharmacother, 2023, 24(15):1665-1671.
[18] 马丽娜.肝硬化合并食管胃静脉曲张破裂出血患者的血流动力学特点及不良结局影响因素分析.罕少疾病杂志,2022,29(4):73-75.
[19] Vaishnav M, Biswas S, Anand A, et al. Hepaticvenous pressure gradient predicts further decompensation in cirrhosis patients with acute esophageal variceal bleeding. Diagnostics (Basel), 2023, 13(14):2385-2385.
[20] 王健苗,杨晶,邱吉.凝血酶散对肝硬化门静脉高压患者血流动力学及肾功能的影响.中国临床药理学杂志. 2020, 36(14):1949-1952.
[21] An Y, Bai Z, Guo X, et al. Effect ofterlipressin on renal function in liver cirrhosis with ascites: a pilot study. J Clin Exp Hepatol, 2020, 10(6):643-645.
[22] Xu X, Liu B, Lin S,et al. Terlipressin may decrease in-hospital mortality of cirrhotic patients with acute gastrointestinal bleeding and renal dysfunction: a retrospective multicenter observational study. Adv Ther, 2020, 37(10):4396-4413.

内镜下套扎联合奥曲肽和凝血酶治疗肝硬化并发食管胃静脉曲张出血患者疗效研究^*

Esophageal variceal ligation with auxiliary oral thrombin and intravenous octreotide administration in the treatment of cirrhotics with esophageal and gastric variceal bleeding

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	韦新焕, 柳雅立, 张晶, 贾继东. 代谢相关性脂肪性肝硬化诊疗进展^*[J]. 实用肝脏病杂志, 2024, 27(5): 641-645.
[2]	张志强, 方坚, 李东良. 介入治疗肝硬化门静脉高压症研究进展与挑战^*[J]. 实用肝脏病杂志, 2024, 27(5): 650-653.
[3]	中国医药生物技术协会慢病管理分会肝病学组. 双环醇防治肝脏炎性损伤多学科专家共识[J]. 实用肝脏病杂志, 2024, 27(5): 659-668.
[4]	彭麟, 杨春, 李兴泉. 聚乙二醇干扰素α-2b联合恩替卡韦治疗HBeAg阳性慢性乙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 677-680.
[5]	冉书容, 刘洋, 雷兰. 恩替卡韦经治的慢性乙型肝炎患者发生低病毒血症危险因素及转换TAF治疗疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 681-684.
[6]	黎防, 杨宏飞, 张青. 索非布韦联合雷迪帕韦治疗慢性丙型肝炎患者疗效评价^*[J]. 实用肝脏病杂志, 2024, 27(5): 685-688.
[7]	刘雅光, 胡连智, 董一侠, 刘洋. 抗病毒治疗的基因1b型慢性丙型肝炎患者疗效及其血清γ-干扰素和白细胞介素-10水平变化^*[J]. 实用肝脏病杂志, 2024, 27(5): 689-692.
[8]	莫伟斌, 张清友, 黄晓涵, 欧阳婉爱. 达诺瑞韦联合拉维达韦治疗慢性丙型肝炎患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 693-696.
[9]	高怡, 沈小雪, 夏素芹, 张洁, 朱先兰. 自身免疫性肝炎和原发性胆汁性胆管炎患者血清胆汁酸成分变化及其对治疗应答的影响^*[J]. 实用肝脏病杂志, 2024, 27(5): 709-712.
[10]	蒋叶舟, 花霞, 陈国飞, 朱青蓝, 蔡明月. 自身免疫性肝炎患者血清瘦素、外周血调节性T细胞和Th17细胞水平变化^*[J]. 实用肝脏病杂志, 2024, 27(5): 713-716.
[11]	朱家瑞, 葛绍锋, 叶桂云, 黄远茂. 自身免疫性肝炎患者外周血NLR和nCD64指数变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2024, 27(5): 717-720.
[12]	王燕燕, 周桐桐, 卞兆连. 原发性胆汁性胆管炎和原发性胆汁性胆管炎-自身免疫性肝炎重叠综合征患者临床与肝组织病理学特点分析^*[J]. 实用肝脏病杂志, 2024, 27(5): 721-724.
[13]	王秀娟, 朱贺, 张茹梦, 常文绘, 刘玉玉. 泼尼松联合硫唑嘌呤治疗自身免疫性肝炎患者不同减量方法的效果研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 729-732.
[14]	信亮亮, 温智. 2D-SWE技术联合FIB-4和血清VEGF水平评估乙型肝炎肝硬化患者食管静脉曲张价值研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 737-740.
[15]	李瑞妮, 王莎莎, 贾泽博, 韦晓洁, 王腾. 聚桂醇和蛇毒血凝酶注射配合内镜下套扎治疗乙型肝炎肝硬化并发EVB患者疗效研究^*[J]. 实用肝脏病杂志, 2024, 27(5): 741-744.