生长抑素与奥曲肽对食管胃底静脉曲张破裂出血患者的临床对照

发布时间：2017-12-28 08:20

本文关键词：生长抑素与奥曲肽对食管胃底静脉曲张破裂出血患者的临床对照　出处：《延安大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:通过回顾性收集进展至肝硬化阶段,出现食管胃底静脉曲张破裂出血的患者,予以不同剂量的生长抑素或者奥曲肽治疗,观察各组患者的止血时间,24h止血率,止血后维持治疗三天后停药后再出血率,用药期间不良反应的发生例数,并观察几组患者的平均住院日、输血量是否具有差异。方法:共收集70例(男41例、女29例)经既往病史、B超、CT、内镜等诊断为肝硬化食管胃底静脉曲张破裂患者,且患者出血量大(大于1000ml),需要输血,根据使用药物及剂量的不同分为三组:其中A组(26例,年龄47.65±15.1岁,体重58.23±8.52Kg):在给予(奥美拉唑注射剂、止血敏、扩容等)一般治疗的基础上加用生长抑素250ug/h,持续微泵滴注。B组(23例,年龄48.87±15.56,体重57.87±7.00Kg):在给予(奥美拉唑注射剂、止血敏、扩容等)一般治疗的基础上给予加倍剂量的生长抑素500ug/h,持续微泵滴注。C组(21例,年龄46.86±14.39岁,体重57.95±6.54Kg):在给予(奥美拉唑注射剂、止血敏、扩容等)一般治疗的基础上给予奥曲肽50ug/h,持续微泵滴注。分别对三组患者的止血时间、24h止血率,停药后再出血率,用药期间不良反应发生率,输血量,平均住院天数进行对比,观察其是否具有统计学意义。结果:1.三组入选病例从年龄、体重、血红蛋白、凝血时间、总蛋白、白蛋白、转氨酶、肌酐、尿素氮等方面进行两两比较,P值均大于0.05,无显著性差异(P0.05),三组患者可以进行两两对比。2.A(普通生长抑素)组与B(加倍生长抑素)组相比:在止血时间上的比较,即(21.80±7.01vs 15.6±5.47),P=0.010.05,两组有显著差异,加倍生长抑素组患者的止血时间短于普通生长抑素组的患者;两组在24h止血率上的比较,即(42.3%vs91.3%),由卡方检验得出χ2=12.935.97,即p0.0166,故而有统计学差异,即加倍生长抑素组止血率明显优于普通生长抑素组;两组在不良反应发生率上的比较,即(7.6%vs4.35%),由卡方检验得出χ2=0.0265.97,则p0.0166,两者无显著性差异,即普通生长抑素组与加倍生长抑素组患者的不良反应未见明显差异;停药3天后再出血率,两组患者中,停药后均未见再出血患者;两组在平均输血量上的比较,即(594.23±301.77vs310.87±116.73),p=0.0100.05,两组有显著差异,即加倍生长抑素组患者的输血量明显低于普通生长抑素组的患者;两组在平均住院日上的比较,即(20.53±3.07vs11.43±1.99),p=0.0420.05,两组有显著差异,即加倍生长抑素组患者的平均住院日明显低于普通生长抑素组。3.a(普通生长抑素)组与c(奥曲肽)组的比较:在止血时间上的比较,即(21.80±7.01vs15.38±6.19),p=0.030.05,两组有显著差异;两组在24h止血率上的比较,即(42.3%vs85.7%),由卡方检验得出χ2=9.265.97,即p0.0166,故而有统计学差异,普通生长抑素组止血率不优于奥曲肽组;两组在不良反应发生率上的比较,即(7.6%vs4.8%),由卡方检验得出χ2=0.0365.97,则p0.0166,两者无显著性差异;停药3天后再出血率,两组患者中停药后均未见再出血患者;两组在输血量上的比较,即(594.23±301.77vs397.62±223.31),p=0.0220.05,两组有显著差异;两组在平均住院日上的比较,即(20.53±3.07vs14.00±1.84),p=0.0470.05,两组有显著差异。4.b(加倍生长抑素)组与c(奥曲肽)组在止血时间上的比较,在止血时间上的比较,即(15.6±5.47vs15.38±6.19),p=0.89800.05,两组无明显差异;两组在24h止血率上的比较,即(91.3%vs85.7%),由卡方检验得出χ2=0.0125.97,则p0.0166,故而无统计学差异,两组的止血率无明显区别;两组在不良反应发生率上的比较,即(4.35%vs4.8%),由卡方检验得出χ2=0.435.97,则p0.0166,两者无显著性差异;停药3天后再出血率,两组患者中,停药后均未见再出血患者;两组在输血量上的比较,即(310.87±116.73vs397.62±223.31),p=0.3230.05,两组无明显差异;两组在平均住院日上的比较,即(11.43±1.99vs14.00±1.84),p=0.7410.05,两组无明显差异。结论:加倍剂量的生长抑素与奥曲肽组在止血时间上无明显差异,而其二者的止血时间均短于普通生长抑素组;加倍剂量的生长抑素与奥曲肽组在的止血率上无明显差异,而其二者的止血率均优于普通生长抑素组;在不良反应发生率中,三者均未见明显差异;三组患者中停药后均未见再出血患者;在平均输血量上,加倍剂量的生长抑素组与奥曲肽组相比,无特异性差异,然两者的输血量均少于普通生长抑素组;平均住院日的比较中,加倍剂量的生长抑素组与奥曲肽组无显著差异,但其二者的平均时间均短于普通生长抑素组。综上可知,加倍剂量的生长抑素组与奥曲肽组在止血时间、止血率、输血量、平均住院日上未见明显差异,且均优于普通生长抑素组,可优先选用于临床。三种药物在止血后维持静滴三天后停药,均可预防患者的再出血。
[Abstract]:Objective: To retrospectively collect progress to cirrhosis, bleeding in patients with esophageal varices, given different doses of somatostatin or octreotide treatment, observe the hemostatic time of patients in each group, 24h hemostatic rate, bleeding after maintaining the rate of rebleeding after three days of treatment discontinuation, the incidence of drug adverse reaction, and observe whether several groups of the average hospitalization days, blood transfusion has difference. Methods: collected 70 cases (male 41 cases, female 29 cases) by anamnesis, ultrasound, CT and endoscopic diagnosis of esophageal varices in patients, and patients with bleeding (more than 1000ml), need a blood transfusion, depending on the use of drugs and doses into three groups: the A group (26 cases, age 47.65 + 15.1, 58.23 + 8.52Kg weight): given (omeprazole injection, dicynone expansion, etc.) on the basis of general treatment plus somatostatin 250ug/h, continuous micro pump infusion. Group B (23 cases, age 48.87 + 15.56, body weight 57.87 + 7.00Kg): on the basis of general treatment (omeprazole injection, hemostasis and dilatation), double dose somatostatin 500ug/h and continuous micro pump infusion were given. Group C (21 cases, age 46.86 + 14.39 years old, weight 57.95 + 6.54Kg): octreotide 50ug/h and continuous micropump infusion were given on the basis of general treatment (omeprazole injection, hemostasis, dilatation and so on). The hemostatic time, 24h hemostasis rate, bleeding rate after drug withdrawal, incidence of adverse reactions during administration, blood transfusion volume and average hospitalization days in three groups were compared respectively to observe whether it has statistical significance. Results: 1.. Three groups of selected cases from age, weight, hemoglobin, clotting time, total protein, albumin, aminotransferase, creatinine, urea nitrogen and other aspects of 22 comparison, P value is greater than 0.05, there is no significant difference (P0.05), three groups of patients can make 22 comparison. 2.A (general somatostatin) and group B (double somatostatin) group: comparison in the hemostasis time, that is (21.80 + 15.6 + 5.47 7.01vs, P=0.010.05), there was significant difference between two groups, double the growth chalone in patients with bleeding time shorter than the ordinary somatostatin group of patients in the two groups; 24h hemostasis the rate of the comparison, namely (42.3%vs91.3%), by chi square test that x 2=12.935.97, namely p0.0166, which had significant difference, namely double somatostatin group hemostatic rate was significantly better than the ordinary somatostatin group; two groups in the incidence of adverse reactions, namely (7.6%vs4.35%), by chi square test that was 2=0.0265.97 p0.0166, no significant difference between two groups, namely ordinary somatostatin group and double somatostatin group had no obvious adverse reactions difference; 3 days after withdrawal of rebleeding, two groups of patients, after drug withdrawal were no rebleeding patients; two groups in the ratio of the average amount of blood transfusion That is, (594.23 + 301.77vs310.87 + 116.73, p=0.0100.05), there was significant difference in two groups, namely the double growth of blood transfusion SS group were lower than that of ordinary somatostatin group; the two groups in the comparison of average hospitalization day, that is (20.53 + 3.07vs11.43 + 1.99), p= 0.0420.05, there was significant difference between two groups that is, double the somatostatin group the average hospitalization days was significantly lower than that of ordinary somatostatin group. 3.a (general somatostatin) and group C (octreotide) group comparison: comparison in the hemostasis time, namely (21.80 + 7.01vs15.38 + 6.19, p=0.030.05), there was significant difference in two groups; the two group in the 24h on the hemostatic rate comparison, namely (42.3%vs85.7%), by chi square test that was 2= 9.265.97. P0.0166, so there was significant difference between ordinary somatostatin group hemostasis rate is not better than the octreotide group; two groups in the incidence of adverse reactions, namely (7.6%vs4.8%), by chi square test that x 2=0.0365.97, p0.0166, there was no significant difference; 3 days after withdrawal of rebleeding, two patients after drug withdrawal were no rebleeding patients; two groups in blood transfusion on the comparison, namely (594.23 + 301.77vs397.62 + 223.31, p=0.0220.05), there was significant difference in two groups; the two groups in the comparison of average hospitalization day, that is (20.53 + 3.07vs14.00 + 1.84, p=0.0470.05), there was significant difference between two groups. 4.b (double somatostatin) group and C group (octreotide) in the hemostasis time, in the time of hemostasis, namely (15.6 + 5.47vs15.38 + 6.19, p=0.89800.05), no significant difference between the two groups; the two group in the 24h on the hemostatic rate comparison, namely (91.3%vs85.7%), by the chi square test x 2=0.0125.97, p0.0166, no significant difference between the two groups. Therefore, the hemostatic rate showed no significant difference between the two groups; compared to the incidence of the adverse reactions, namely (4.35%vs4.8%), by chi square test that x 2=0.435.97, p0.0166, there was no significant difference; 3 days after withdrawal of rebleeding, two patients and after drug withdrawal were no rebleeding patients; two groups in blood transfusion on the comparison, namely (310.87 + 116.73vs397.62 + 223.31, p=0.3230.05), no significant difference between the two groups; the two groups in the comparison of average hospitalization day, that is (11.43 + 1.99vs14.00 + 1.84, p=0.7410.05), no significant difference between the two groups. Conclusion: there is no significant difference between somatostatin and octreotide group double dose in the hemostasis time, and bleeding time were shorter than the ordinary somatostatin group; double dose of somatostatin and octreotide group had no significant difference in the rate of hemostasis, and the hemostasis rate are better than ordinary in the somatostatin group; the incidence of adverse reactions in three, there were no significant differences between the three groups; after drug withdrawal were no rebleeding; in the average amount of blood transfusion, compared with somatostatin group and octreotide group of double dose, no specific difference in blood transfusion but both were less than the ordinary somatostatin group; the average hospitalization days in comparison, double dose somatostatin group and octreotide group had no significant difference, but the average time were shorter than the ordinary somatostatin group. In conclusion, double dose somatostatin group and octreotide group had no significant difference in hemostasis time, hemostasis rate, blood transfusion volume and average hospitalization days, and all were superior to those in normal somatostatin group.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R575.2

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