内镜曲张静脉套扎术联合生长抑素和艾司奥美拉唑治疗肝硬化并发食管胃静脉曲张破裂出血患者疗效研究*

doi:10.3969/j.issn.1672-5069.2025.03.023

摘要/Abstract

摘要： 目的探讨内镜下曲张静脉套扎术(EVL)联合生长抑素和艾司奥美拉唑治疗肝硬化并发食管胃静脉曲张破裂出血(EVB)患者的临床疗效。方法 2022年4月～2024年4月我院收治的77例肝硬化并发EVB患者,被随机分为对照组38例和观察组39例,分别给予生长抑素和艾司奥美拉唑治疗或采用EVL联合这些药物治疗。使用多普勒超声诊断仪检测门静脉内径(DPV)、血流速度(Vpv)和血流量(Qpv),使用全自动凝血分析仪检测凝血功能指标。结果在急性期,观察组止血有效率为97.4%,对照组为84.2%(P<0.05);观察组输血量、止血时间、补充白蛋白量和住院日分别为(240.3±131.4)mL、(3.7±0.5)h、(10.4±2.9)g和(5.7±0.8)d,均显著少于或短于对照组【分别为(596.2±238.9)mL、(44.3±4.1)h、(44.2±12.5)g和(11.6±1.4)d,P<0.05】;在术后14 d,观察组Vpv和Qpv分别为(15.8±2.2)cm/s和(944.2±245.5)mL/min,均显著快于或大于对照组【分别为(13.4±2.3)cm/s和(776.7±170.6)mL/min,P<0.05】;观察组血清纤维蛋白原水平为(2.9±0.5)g/L,显著高于对照组【(2.2±0.6)g/L,P<0.05】;在术后6个月,观察组再出血率和EV复发率分别为2.6%和7.9%,均显著低于对照组的18.8%和25.0%(P<0.05)。结论采用EVL联合静脉应用生长抑素和艾司奥美拉唑治疗肝硬化并发EVB患者止血效果好,减少了输血和补充蛋白消耗,值得总结经验,扩大应用。

关键词: 肝硬化, 食管胃静脉曲张破裂出血, 内镜下曲张静脉套扎术, 生长抑素, 艾司奥美拉唑, 治疗

Abstract: Objective The aim of this study was to investigate clinical efficacy of endoscopic variceal ligation (EVL) and somatostatin and esomeprazole combination in the treatment of patients with liver cirrhosis (LC) with complicated esophagogastric variceal bleeding(EVB). Methods Consecutive 77 patients with LC and complicated EVB were encountered in our hospital between April 2022 and April 2024, and were randomly divided into control (n=38) and observation (n=39) group, receiving intravenous infusion of somatostatin and esomeprazole, or receiving EVL plus intravenous infusion of the two medicines. Portal vein diameter (Dpv), portal vein blood flow velocity (Vpv) and portal vein blood flow volume (Qpv) were detected by Doppler ultrasonography. Results For hemostasis, blood transfusion, bleeding-stopping time, supplemented albumin and hospital stay in the observation group were (240.3±131.4)mL,(3.7±0.5)h,(10.4±2.9)g and (5.7±0.8)d, all much less or shorter than [(596.2±238.9)mL, (44.3±4.1)h, (44.2±12.5)g and (11.6±1.4)d, respectively, P<0.05]in the control; 14 days after treatment, Vpv and Qpv in the observation were (15.8±2.2)cm/s and (944.2±245.5)mL/min, both significantly faster or greater than [(13.4±2.3)cm/s and (776.7±170.6)mL/min, respectively, P<0.05] in the control; serum fibrinogen level was(2.9±0.5)g/L, much higher than [(2.2±0.6)g/L, P<0.05] in the control; the emergent hemostasis rate in the observation was 97.4%, much higher than 84.2%(P<0.05)in the control; by end of six month follow-up, re-bleeding rate was 2.6% and esophagogastric varices relapse was 7.9%, both much lower than 18.8% and 25.0%(P<0.05)in the control group. Conclusion EVL at base of intravenous infusion of somatostatin and esomeprazole in the treatment of patients with LC and EVB is efficacious with high emergent hemostasis, and less rebleeding and low EV relapse.

Key words: Liver cirrhosis, Esophagogastric variceal bleeding, Endoscopic variceal ligation, Somatostatin, Esomeprazole, Therapy

许荣波, 王艳, 王晓松, 王晓燕. 内镜曲张静脉套扎术联合生长抑素和艾司奥美拉唑治疗肝硬化并发食管胃静脉曲张破裂出血患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 410-413.

Xu Rongbo, Wang Yan, Wang Xiaosong, et al. Efficacy of endoscopic variceal ligation and somatostatin and esomeprazole combination in the treatment of patients with liver cirrhosis with complicated esophagogastric variceal bleeding[J]. Journal of Practical Hepatology, 2025, 28(3): 410-413.

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内镜曲张静脉套扎术联合生长抑素和艾司奥美拉唑治疗肝硬化并发食管胃静脉曲张破裂出血患者疗效研究^*

Efficacy of endoscopic variceal ligation and somatostatin and esomeprazole combination in the treatment of patients with liver cirrhosis with complicated esophagogastric variceal bleeding

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