许圣华

[摘要] 目的 探讨肝硬化合并上消化道出血的患者使用凝血酶联合奥曲肽的治疗效果。方法 随机选择2015年6月—2017年1月在该院诊治的肝硬化合并上消化道出血的患者180例，随机分为3组，每组60例，A组使用奥曲肽，B组使用凝血酶，C组使用凝血酶联合奥曲肽，观察患者的疗效，监测止血时间、住院的时间、输血量、再出血等。结果 C组的总有效率为96.67%，明显高于A组、B组，差异有统计学意义（P<0.05）；C组的止血时间为（18.79±2.53）h、住院的时间为（4.11±1.52）d、输血量（201.04±48.56）mL、再出血率8.33%，C组明显优于A组、B组，差异有统计学意义（P<0.05）；A组和B组的总有效率、止血时间、住院时间、输血量、再出血，差异无统计学意义（P>0.05）。结论 奥曲肽和凝血酶联合使用治疗肝硬化合并上消化道出血效果较好，在临床上可广泛使用。

[关键词] 奥曲肽；凝血酶；肝硬化合并上消化道出血；疗效

[中图分类号] R573 [文献标识码] A [文章编号] 1674-0742（2017）11（a）-0010-03

[Abstract] Objective To discuss the curative effect of octreotide and thrombin in treatment of cirrhosis and upper gastrointestinal hemorrhage. Methods 180 cases of patients with cirrhosis and upper gastrointestinal hemorrhage diagnosed in our hospital from June 2015 to January 2017 were randomly selected and randomly divided into three groups with 60 cases in each， the group A， group B and group C were respectively treated with octreotide， thrombin and the combination of octreotide and thrombin， and the curative effect， hemostasis time， length of stay， transfusion amount and rebleeding were observed. Results The total effective rate in the group C was obviously higher than that in the group A and group B， which was 96.67% in the group C， and the difference was statistically significant（P<0.05）， and the hemostasis time， length of stay， transfusion amount and rebleeding in the group C were respectively （18.79±2.53）h， （4.11±1.52）d， （201.04±48.56）mL， 8.33%， which were obviously better than those in the group A and group B， and the differences were statistically significant（P<0.05）， and the differences in these indexes between the group A and group B were not big without statistical significance（P>0.05）. Conclusion The effect of combination of octreotide and thrombin in treatment of cirrhosis and upper gastrointestinal hemorrhage is good， which can be widely applied in clinic.

[Key words] Octreotide； Thrombin； Cirrhosis and upper gastrointestinal hemorrhage； Curative effect

肝硬化是較常见的慢性进行性肝病，是由一种或者多种病因长期或反复作用形成的弥漫性肝损害。在我国主要是肝炎后肝硬化，有少量的酒精性肝硬化和血吸虫性肝硬化[1]。肝硬化早期肝脏可有代偿功能，后期则出现肝功能损害和门脉高压，晚期可有上消化道出血、肝性脑病、腹水、继发感染等并发症。在临床上上消化道出血是较常见的并发症，而且较严重，发作时出血量较大，病情变化较快，可危及生命，因此要及时采取有效措施进行止血[2]。在临床上较长见药物止血和内镜止血，药物止血种类较多[3]，现讨论奥曲肽和凝血酶的止血效果。

1 资料与方法

1.1 一般资料

随机选择在该院诊治的肝硬化合并上消化道出血患者180例，随机分为3组，每组60例。A组使用奥曲肽，男36例，女24例，年龄28～76岁，平均年龄（44.24±7.58）岁，出血量450～2 000 mL，平均出血量（856.23±390.67）mL，胃底静脉曲张破裂35例，食管静脉曲张破裂25例。B组使用凝血酶，男31例，女29例，年龄30～74岁，平均年龄（45.04±7.99）岁，出血量500～2 000 mL，平均出血量（878.03±385.12）mL，胃底静脉曲张破裂30例，食管静脉曲张破裂30例。C组使用奥曲肽联合凝血酶，男38例，女22例，年龄31～70岁，平均年龄（43.24±8.18）岁，出血量500～2 000 mL，平均出血量（849.93±379.97）mL，胃底静脉曲张破裂29例，食管静脉曲张破裂31例。3组患者的一般资料、出血量等比较差异无统计学意义（P>0.05）。endprint