特利加压素在食管胃底静脉曲张破裂出血及肝切除术后的应用
发布时间：2019-03-29 13:56
【摘要】：第一部分:特利加压素在食管胃底静脉曲张破裂出血患者中的应用[目的]:观察特利加压素在食管胃底静脉曲张破裂出血患者中的临床疗效,进而评价治疗的有效性、安全性。[方法]:回顾性分析昆明医科大学第一附属医院传染科2016年9月-2017年3月住院的食管胃底静脉曲张破裂出血患者30例,根据是否使用特利加压素将其分为观察组12例和对照组18例,两组均采取禁食禁饮、吸氧、输液、补充血容量等基础治疗,观察组在此基础上加用特利加压素(2mg/4h,出血停止后改为2次/d、1mg/次,连续使用5d),对照组予生长抑素(首剂250ug静脉推注,后续250ug/h持续泵入,连续使用5d),观察比较两组治疗效果及恢复情况。[结果]:两组患者在性别组成、年龄、肝肾功能水平、胃底食管静脉曲张程度、Child-Pugh分级等一般资料方面差异无统计学意义(P0.05);两组止血时间分别为15.7±1.9h、21.9±3.5h,差异具有统计学意义(P0.05),止血成功分别为11例(91.6%)、16例(88.9%),再出血分别为1例(8.3%)、2例(11.1%),差异无统计学意义(P0.05)。与入院当天比较,两组治疗后门静脉、脾静脉内径均有缩小,但观察组改善较明显,组间比较:观察组治疗后门静脉、脾静脉内径分别为11.±1.0mm、8.1±0.8mm;对照组治疗后门静脉、脾静脉内径分别为12.1±0.9mm、9.2±0.9mm,两组间差异均有统计学意义(P0.05)。[结论]:在治疗食管胃底静脉曲张破裂出血时,特利加压素在止血时间上优于生长抑素,止血率、再出血率二者无明显差别;特利加压素在改善门静脉、脾静脉内径方面优于生长抑素,降低门静脉压力作用更显著。第二部分:特利加压素对肝切除术后患者肝肾功能的保护[目的]:观察特利加压素在半肝切除后患者中的临床疗效,探讨其对肝切除术后肝肾功能的保护作用,进而评价治疗的有效性、安全性。[方法]:回顾性分析昆明医科大学第一附属医院器官移植科2016年3月-2017年3月行半肝切除治疗的原发性肝癌患者48例,根据是否使用特利加压素将其分为观察组20例和对照组28例,两组术后均予保肝、利尿、补充白蛋白、改善微循环等基础治疗,观察组在此基础上加用特利加压素(2mg/d持续泵入,连续使用5d),观察比较两组治疗前后临床指标变化。[结果]:两组患者在性别组成、年龄、肝肾功能水平、Child-Pugh分级、病灶大小、术中情况等一般资料方面差异无统计学意义(P0.05);与术后第一天比较,两组患者术后第3、5天肝肾功能指标、24h尿量、腹腔引流量均有改善,观察组改善较对照组显著。组间比较:观察组术后3、5天肝肾功能指标分别为ALT112.6±11.6U/L、39.9±4.1U/L,AST118.1±7.6U/L、45.4±4.5U/L,Tbil 19.9±1.9umol/L、11.0±2.3umol/L,BUN 7.3±1.0mmol/L、6.2±10.7mmol/L,Scr 72.4±3.5umol/L、63.8±2.6umol/L;对照组术后3、5天肝肾功指标分别为ALT 122.5±10.6U/L、50.8±3.8U/L,AST 126.3±3.3U/L、49.0±4.9U/L,Tbil21.3±1.6 umol/L、12.7±2.5umol/L,BUN7.8±0.7mmol/L、7.1±0.8mmol/L,Scr76.1±6.5 umol/L、69.3±5.4umol/L,两组间差异均有统计学意义(P0.05)。观察组术后3、5 天 24h 尿量分别为 2102.5±142.8ml、2252.8±152.4ml;对照组术后 3、5 天 24h尿量分别为1964.3±131.8ml、2092.9±103.4ml,两组间差异均有统计学意义(P0.05)。观察组术后3、5天腹腔引流量分别为113.0±8.6ml、35.8±8.8ml;对照组术后3、5天腹腔引流量分比为131.1±12.9ml、43.9±9.8ml,两组间差异均有统计学意义(P0.05)。观察组术后腹腔引流时间及住院时间分别为5.1±0.8d、7.8±1.2d,对照组术后腹腔引流时间及住院时间分别为6.6±1.1d、10.9±1.0d,两组间差异均有统计学意义(P0.05)。[结论]:特利加压素能够减轻半肝切除术后肝功能损害、减少腹腔积液形成、改善肾功能、缩短腹腔引流时间、住院时间,提高围手术期安全性,符合快速康复外科原则。
[Abstract]:The first part: The application of terlipressin in the patients with esophageal varicosis and hemorrhage[Objective]: To observe the clinical curative effect of terlipressin in the patients with esophageal varicosis and hemorrhage, and to evaluate the effectiveness and safety of the treatment. [Methods]: A retrospective analysis of 30 cases of gastroesophageal variceal bleeding from the first Affiliated Hospital of Kunming Medical University from September 2016 to March 2017 was retrospectively analyzed. According to the use of terlipressin, it was divided into 12 cases of observation group and 18 cases of control group. In the two groups, on the basis of the basic treatment of fasting, drinking, oxygen inhalation, infusion, and supplementary blood volume, the observation group was treated with terlipressin (2 mg/4 h, after the bleeding was stopped to 2 times/ d,1 mg/ d, for 5 days in succession), and the control group was given somatostatin (first dose of 250 ug of vein). After 250 ug/ h, the treatment effect and recovery of the two groups were compared. [Results] There was no significant difference between the two groups in general data such as sex, age, function of liver and kidney, degree of esophageal varicosity, and Child-Pugh classification (P0.05). The success of hemostasis was 11 (91.6%),16 (88.9%), and rebleeding in 1 (8.3%),2 (11.1%), and no significant difference (P0.05). Compared with the day of admission, the internal diameter of the portal vein and the splenic vein of the two groups was reduced, but the observation group was obviously improved, and the internal diameter of the portal vein and the splenic vein after the treatment of the observation group was 11. The internal diameter of the portal vein and the splenic vein after treatment in the control group was 12.1, 0.9, 9.2 and 0.9 mm, respectively, and the difference between the two groups was statistically significant (P0.05). [Conclusion]: In the treatment of the bleeding of the esophageal varices, terlipressin is better than that of the somatostatin, the hemostatic rate and the rebleeding rate in the time of hemostasis, and the terlipressin is superior to the somatostatin in the improvement of the internal diameter of the portal vein and the splenic vein. And the effect of the portal pressure is reduced to be more significant. The second part: The protective effect of terlipressin on the function of liver and kidney after hepatectomy[Objective]: To observe the clinical effect of terlipressin in the patients with partial hepatectomy and to explore the protective effect of terlipressin on the function of liver and kidney after hepatectomy, and to evaluate the effectiveness and safety of the treatment. [Methods]: A retrospective analysis of 48 cases of primary liver cancer in the first Affiliated Hospital of Kunming Medical University from March 2016 to March 2017 was analyzed retrospectively. In the treatment of diuresis, the addition of albumin, and the improvement of microcirculation, the observation group was treated with terlipressin (2 mg/ d continuously for 5 days), and the clinical index changes before and after treatment were observed. [Results]: There was no significant difference between the two groups in general data such as sex, age, liver and kidney function, Child-Pugh classification, size of focus, and intra-operative condition (P0.05). The flow rate of the abdominal cavity was improved, and the improvement of the observation group was more significant than that of the control group. The liver and kidney function indexes were ALT112.6, 11.6U/ L, 39.9, 4.45U/ L, Tbil 19.9, 1.9umol/ L, 11.7mmol/ L, Scr 72.4, 3.5umol/ L, 63.8-2.6uml/ L, respectively, and the indexes of liver and kidney work of 3 and 5 days after operation in the control group were ALT 122.5, 10.6 U/ L, 50.8-3.8U/ L, respectively. AST 126.3-3.3 U/ L, 49.0-4.9U/ L, Tbili21.3, 1.6umol/ L, 12.7-2.5umol/ L, BUN7.8-0.7 mmol/ L, 7.1-0.8 mmol/ L, Scr76.1-6.5mg/ L, 69.3-5.4umol/ L, and the difference between the two groups was statistically significant (P0.05). The urine volume of 3 and 5 days after operation in the observation group was 2102.5, 142.8 ml, 2252.8 and 152.4 ml, respectively. The urine volume in the control group was from 1964.3 to 131.8 ml, 2092.9 to 103.4 ml, and the difference between the two groups was statistically significant (P0.05). After 3 and 5 days after operation of the observation group, the flow rate of the abdominal cavity was 113.0, 68.6 ml, 35.8 and 8.8 ml, respectively. The flow rate of the abdominal cavity in the control group was 131.1, 12.9 ml, 43.9-9.8 ml, and the difference between the two groups was statistically significant (P0.05). The time of intra-abdominal drainage and the time of hospital stay in the observation group were 5.1, 0.8d, 7.8 and 1.2d, respectively. The time of the abdominal drainage and the hospital stay in the control group were 6.6%, 1.1 d, 10.9% and 1.0 d, respectively, and the difference between the two groups was statistically significant (P0.05). [Conclusion]: Terlipressin can reduce the hepatic function damage after the partial hepatectomy, reduce the formation of the peritoneal effusion, improve the renal function, shorten the time of the abdominal drainage, the hospital stay, improve the safety of the perioperative period, and meet the principles of rapid rehabilitation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3
本文编号：2449613
[Abstract]:The first part: The application of terlipressin in the patients with esophageal varicosis and hemorrhage[Objective]: To observe the clinical curative effect of terlipressin in the patients with esophageal varicosis and hemorrhage, and to evaluate the effectiveness and safety of the treatment. [Methods]: A retrospective analysis of 30 cases of gastroesophageal variceal bleeding from the first Affiliated Hospital of Kunming Medical University from September 2016 to March 2017 was retrospectively analyzed. According to the use of terlipressin, it was divided into 12 cases of observation group and 18 cases of control group. In the two groups, on the basis of the basic treatment of fasting, drinking, oxygen inhalation, infusion, and supplementary blood volume, the observation group was treated with terlipressin (2 mg/4 h, after the bleeding was stopped to 2 times/ d,1 mg/ d, for 5 days in succession), and the control group was given somatostatin (first dose of 250 ug of vein). After 250 ug/ h, the treatment effect and recovery of the two groups were compared. [Results] There was no significant difference between the two groups in general data such as sex, age, function of liver and kidney, degree of esophageal varicosity, and Child-Pugh classification (P0.05). The success of hemostasis was 11 (91.6%),16 (88.9%), and rebleeding in 1 (8.3%),2 (11.1%), and no significant difference (P0.05). Compared with the day of admission, the internal diameter of the portal vein and the splenic vein of the two groups was reduced, but the observation group was obviously improved, and the internal diameter of the portal vein and the splenic vein after the treatment of the observation group was 11. The internal diameter of the portal vein and the splenic vein after treatment in the control group was 12.1, 0.9, 9.2 and 0.9 mm, respectively, and the difference between the two groups was statistically significant (P0.05). [Conclusion]: In the treatment of the bleeding of the esophageal varices, terlipressin is better than that of the somatostatin, the hemostatic rate and the rebleeding rate in the time of hemostasis, and the terlipressin is superior to the somatostatin in the improvement of the internal diameter of the portal vein and the splenic vein. And the effect of the portal pressure is reduced to be more significant. The second part: The protective effect of terlipressin on the function of liver and kidney after hepatectomy[Objective]: To observe the clinical effect of terlipressin in the patients with partial hepatectomy and to explore the protective effect of terlipressin on the function of liver and kidney after hepatectomy, and to evaluate the effectiveness and safety of the treatment. [Methods]: A retrospective analysis of 48 cases of primary liver cancer in the first Affiliated Hospital of Kunming Medical University from March 2016 to March 2017 was analyzed retrospectively. In the treatment of diuresis, the addition of albumin, and the improvement of microcirculation, the observation group was treated with terlipressin (2 mg/ d continuously for 5 days), and the clinical index changes before and after treatment were observed. [Results]: There was no significant difference between the two groups in general data such as sex, age, liver and kidney function, Child-Pugh classification, size of focus, and intra-operative condition (P0.05). The flow rate of the abdominal cavity was improved, and the improvement of the observation group was more significant than that of the control group. The liver and kidney function indexes were ALT112.6, 11.6U/ L, 39.9, 4.45U/ L, Tbil 19.9, 1.9umol/ L, 11.7mmol/ L, Scr 72.4, 3.5umol/ L, 63.8-2.6uml/ L, respectively, and the indexes of liver and kidney work of 3 and 5 days after operation in the control group were ALT 122.5, 10.6 U/ L, 50.8-3.8U/ L, respectively. AST 126.3-3.3 U/ L, 49.0-4.9U/ L, Tbili21.3, 1.6umol/ L, 12.7-2.5umol/ L, BUN7.8-0.7 mmol/ L, 7.1-0.8 mmol/ L, Scr76.1-6.5mg/ L, 69.3-5.4umol/ L, and the difference between the two groups was statistically significant (P0.05). The urine volume of 3 and 5 days after operation in the observation group was 2102.5, 142.8 ml, 2252.8 and 152.4 ml, respectively. The urine volume in the control group was from 1964.3 to 131.8 ml, 2092.9 to 103.4 ml, and the difference between the two groups was statistically significant (P0.05). After 3 and 5 days after operation of the observation group, the flow rate of the abdominal cavity was 113.0, 68.6 ml, 35.8 and 8.8 ml, respectively. The flow rate of the abdominal cavity in the control group was 131.1, 12.9 ml, 43.9-9.8 ml, and the difference between the two groups was statistically significant (P0.05). The time of intra-abdominal drainage and the time of hospital stay in the observation group were 5.1, 0.8d, 7.8 and 1.2d, respectively. The time of the abdominal drainage and the hospital stay in the control group were 6.6%, 1.1 d, 10.9% and 1.0 d, respectively, and the difference between the two groups was statistically significant (P0.05). [Conclusion]: Terlipressin can reduce the hepatic function damage after the partial hepatectomy, reduce the formation of the peritoneal effusion, improve the renal function, shorten the time of the abdominal drainage, the hospital stay, improve the safety of the perioperative period, and meet the principles of rapid rehabilitation.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.3
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