关键词: 食管静脉曲张破裂出血, 生长抑素, 奥曲肽, 多谱勒超声, 系统性血流动力学, 肝脏血流动力学

Abstract: Objective To investigate the efficacy of somatostatin（SS）,octreotide（OC） and pitressin plus nitroglycerin（PN） in the treatment of patients with acute variceal bleeding. Methods 224 patients with acute esophageal and gastric variceal hemorrhage were randomly divided into three groups,receiving SS （group,n=68）,OC（group B,n=73） and pitressin plus PN（group C,n=83） treatment,respectively. The Doppler ultrasound parameters in the three groups were measured before,during and after the treatment. Results The bleeding control rates at 24 h,48 h and 72 h in group A were 67.7%,73.5% and 91.2%,and in group B were 68.5%,72.6% and 91.8%,significantly higher than 50.6%,54.2% and 80.0% in group C,respectively（P<0.05）;the bleeding-controlled time in group A was （32.7±6.8） h,and in group B was （33.8±8.0） h,significantly shorter than （44.6±15.4） h in group C （P<0.05）;the portal vein diameters （PVD）,portal vein velocities （PVV）,blood flow （PVF）,and hepatic artery pulsatility index（HA-PI） in the three groups 12 h after treatment were significantly reduced as compared with those before treatment;the results of systematic hemodynamic parameters showed that the heart rates （HR） and cardiac outputs （CO） were significantly decreased,while the mean arterial pressure（MAP） did not change significantly in group A and in group B,but the HR and MAP significantly increased in group C 12 h after treatment. Conclusions SS and OC were more effective with less side effects than PN for treatment of patients with acute variceal hemorrhage,and the mechanism might be the reduction of cardiac output and contraction of visceral blood vessels,which reduce the portal vein blood flow and portal pressure.

Key words: Esophageal varices bleeding, Somatostatin, Octreotide, Doppler ultrasound, Systemic hemodynamic, Hepatic hemodynamic parameters