内镜套扎术联合生长抑素治疗食管静脉曲张破裂出血的疗效分析

发布时间：2018-04-01 12:16

本文选题：食管静脉曲张破裂出血　切入点：内镜套扎术　出处：《广西中医药大学》2016年硕士论文

【摘要】：目的:分别对内镜套扎术联合生长抑素及单纯内镜套扎术治疗食管静脉曲张破裂出血进行回顾性分析,探讨上述两种方法对食管静脉曲张破裂出血治疗的效果及并发症的研究,旨在为促进对EVB的临床治疗方式的进一步了解,评价两种方法的效果及应用价值,并对并发症进一步预防。方法:本研究回顾性分析了2013年1至2015年9月在广西中医药大学第一附属医院消化内科和肝病科因肝硬化食管静脉曲张破裂出血而行住院治疗的106例患者,并分成治疗组和对照组,均给予标准内科保守治疗,如止血、抑酸、抗感染、扩容等,在抑酸剂的使用上,两组均使用了注射用埃索美拉唑钠治疗。在此基础上治疗组给予了内镜套扎术联合生长抑素治疗,对照组给予了单纯内镜套扎治疗,分别记录患者的临床资料、平均套扎治疗次数、均次套扎环数,随访术后止血、再出血情况、死亡、并发症等情况,采用统计学方法对数据进行处理及分析,结合临床效果进行评价。结果:106例病例共分成两组。内镜联合药物组共54例,男44例,女10例,年龄在28~67岁;内镜组共52例,男45例,女7例,年龄在32~66岁,两组患者在年龄、性别、病因、肝功能分级、食管静脉曲张程度及红色征对比上P值均0.05,差异无统计学意义,两组具有可比性。两组止血成功率分别为96.3%、92.3%,消除率分别为3.7%、7.7%,平均每次套扎环数分别为6.74±0.620、6.83±0.474,迟发性再出血率分别为9.3%、15.4%,死亡率分别为5.56%、9.61%,P0.05,差异无统计学意义,两组在止血效果、静脉曲张消除、每次套扎环数、迟发性再出血、死亡情况上无显著差别。两组显效率分别为29.6%、11.5%,平均治疗疗程次数上分别为2.04±0.334、2.25±0.682,早期再出血率分别为1.9%、13.5%,P0.05,差异有统计学意义,内镜联合药物组在起效速度上比内镜组更快,可以减少套扎治疗次数并减少早期再出血的发生。根据两组数据得出两组术后不良反应中,术后发热、吞咽梗阻感是比较常见的不良反应,但两组在术后发热、胸骨后疼痛、吞咽梗阻感及恶心呕吐的发生率比较,均为P0.05,差异无统计学意义。结论:通过本研究,对于肝硬化食管静脉曲张破裂出血的患者,比较内镜套扎联合生长抑素组和单纯内镜套扎组两组的止血成功率、平均套扎次数、平均套扎环数、再出血率、并发症、死亡率得出下列结论:内镜套扎术联合生长抑素治疗组在止血效果、均次套扎环数、静脉曲张消除率、并发症、死亡率上与单纯内镜组无显著差异,但比单纯内镜套扎治疗可以减少套扎治疗次数,并更大程度上减轻了静脉曲张的情况,效果更加明显,且早期再出血率明显低于内镜组。对此,临床上可以根据患者的不同情况对这两种治疗方法进行选择。
[Abstract]:Objective: to study the effects and complications of endoscopic ligation combined with somatostatin and endoscopic ligation alone in the treatment of esophageal variceal bleeding.In order to promote the further understanding of the clinical treatment of EVB, to evaluate the effect and application value of the two methods, and to prevent the complications.Methods: from January 2013 to September 2015, 106 patients who were hospitalized in the Department of Digestive Medicine and the Department of liver Diseases of the first affiliated Hospital of Guangxi University of traditional Chinese Medicine for esophageal variceal hemorrhage due to cirrhosis were analyzed retrospectively.They were divided into treatment group and control group. Both groups were given standard conservative medical treatment, such as hemostasis, acid suppression, anti-infection, expansion, etc. In the use of acid suppressant, both groups were treated with esomeprazole sodium for injection.On this basis, the treatment group was treated with endoscopic ligation combined with somatostatin, while the control group was treated with simple endoscopic ligation.The data were processed and analyzed by statistical method, and the clinical effect was evaluated.Results 106 cases were divided into two groups.There were 54 patients (44 males, 10 females, aged 2867 years) in the endoscopic combined drug group, 52 patients (45 males and 7 females) in the endoscopic group, aged 32 to 66 years. The patients in the two groups were aged, sex, etiology, liver function grade, age, sex, etiology and liver function grade.The degree of esophageal varices and the red sign were both 0.05, there was no significant difference between the two groups.There was no significant difference in the number of rings per ligation, delayed rebleeding and death.The effective rate of the two groups was 29.6g / 11.5, the average treatment course was 2.04 卤0.334U 2.25 卤0.682, and the rate of early rebleeding was 1.9and 13.5g / P0.05respectively. There was significant difference between the two groups. The effective rate of the endoscopic combined drug group was faster than that of the endoscopic group.Can reduce the number of ligation treatment and reduce the occurrence of early re-bleeding.According to the data of the two groups, fever and dysphagia were common adverse reactions in the two groups, but the incidence of fever, poststernal pain, dysphagia and nausea and vomiting were compared between the two groups.The difference was not statistically significant (P 0.05).Conclusion: in this study, the hemostatic success rate, the average number of ligation times, the average number of ligation loops and the rate of rebleeding were compared between the endoscopic ligation combined with somatostatin group and the simple endoscopic ligation group for patients with esophageal variceal bleeding.Complications and mortality: there was no significant difference in hemostatic effect, number of times of ligation, elimination rate of varicose vein, complication and mortality of endoscopic ligation combined with somatostatin group.But compared with endoscopic ligation alone, the frequency of ligation was reduced, and the varicose vein was alleviated to a greater extent, and the rate of early rebleeding was significantly lower than that of endoscopic group.Therefore, the two treatments can be selected according to the different conditions of the patients.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R575.2

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