生肌止血散内镜下喷洒治疗上消化道出血疗效及药理实验

发布时间：2018-04-26 08:09

本文选题：非静脉曲张性上消化道出血 + 生肌止血散　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：本研究拟对急性非静脉曲张性上消化道出血(ANVUGIB)患者进行内镜下喷洒生肌止血散治疗,观察其止血疗效及临床安全性,以期为本病的治疗提供一种新的止血方法。同时通过观察生肌止血散对胃出血大鼠模型的作用,探讨其止血机制,为该方临床应用提供药理依据。方法：一、临床研究：选取2014年3月到2016年1月期间广东省第二中医院住院患者中符合纳入标准的热盛迫血型ANVUGIB患者60例,随机分为试验组(胃镜下喷洒生肌止血散)和对照组(胃镜下喷洒去甲肾上腺素),每组30例,两组患者术前均予泮托拉唑制酸及营养支持等常规治疗,待患者生命体征平稳后,于出血24小时内给予胃镜下药物喷洒治疗,内镜下治疗后两组患者均继续采用与治疗前相同的治疗方案。观察记录两组患者内镜下止血治疗后5min内即时止血情况,对两组治疗后的即时止血率、大便潜血转阴率、平均止血时间、平均住院时间、总有效率等数据观察比较,并对资料进行统计学分析。二、实验研究：将40只大鼠随机分为空白组(10只)和模型组(30只),模型组采用吲哚美辛灌胃复制胃出血大鼠模型,将造模后的大鼠随机分为模型组(10只)、阳性对照组(10只)、实验组(10只),实验组给予生肌止血散溶液灌胃,阳性对照组给予云南白药溶液灌胃,空白组、模型组给予等量生理盐水灌胃,分别于造模后0.5h和3h各灌胃1次。14h后腹主动脉取血,并摘除大鼠全胃。比较各组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)及胃黏膜出血点情况,结果进行统计学分析,以探讨生肌止血散的止血机制。结果：一、临床研究：即时止血率方面,试验组的即时止血率为96.67%,试验组优于对照组(76.67%)(P0.05)。再出血率方面：试验组的再出血率3.33%,试验组的显著低于对照组(20%)(P0.05)。大便潜血转阴率方面：试验组的大便潜血转阴率为90%,试验组显著高于对照组(60%)(P0.05)。平均止血时间方面：试验组的平均止血时间为31.43±7.67h,试验组显著低于对照组(44.20±17.15h)(P0.01)。住院时间方面：试验组平均住院时间为6.400±1.482 d,试验组明显短于对照组(7.267±1.680 d)(P0.05)。总有效率方面：试验组的总有效率96.67%,试验组明显高于对照组(83.33%)(P0.05)。二、动物实验方面：PT:空白组的平均PT为11.020±1.698秒,模型组的为12.650±0.642秒,对照组的为10.860±1.318秒,实验组为9.600±0.804秒,与模型组比较,空白组、阳性对照组、试验组均显著性降低(P0.01)；与阳性对照组比较,试验组显著性降低(P0.05)。APTT:空白组的平均APTT为21.850±3.101秒,模型组的为25.980±3.602秒,对照组的为20.900±2.428秒,实验组为20.540±2.208秒,与模型组比较,空白组、阳性对照组、试验组均显著性降低(P0.01)。TT:空白组的TT为58.650±4.880秒,模型组的为64.810±3.704秒,对照组的为54.190±3.990秒,实验组为52.730±5.865秒,与模型组比较,空白组、阳性对照组、试验组均显著性降低(P0.01)。胃粘膜出血点：空白组的胃粘膜无出血点,模型组的为30.400±4.858个,对照组的为16.200±3.615个,实验组为10.800±2.378个,与模型组胃粘膜出血点水平比较,空白组、阳性对照组、试验组均显著性降低(P0.01)；与阳性对照组胃粘膜出血点水平比较,试验组显著性降低(P0.01)。结论：临床试验表明：1.生肌止血散治疗能迅速止血,提高ANVUGIB患者的止血率、大便的转阴率及治疗的总有效率。2.生肌止血散治疗能缩短ANVUGIB患者的止血时间及住院时间。3.在本试验中生肌止血散治疗后未出现不良反应。动物实验表明：1.生肌止血散可能启动大鼠的内源性凝血及外源性凝血,改善大鼠的凝血功能。2.生肌止血散能促进损伤粘膜的愈合,降低大鼠的胃粘膜出血点。综合上所述,生肌止血散内镜下喷洒止血临床疗效好,无不良反应,可以在临床上推广应用。
[Abstract]:Objective: To investigate the efficacy and safety of the treatment of acute non variceal upper gastrointestinal bleeding (ANVUGIB) patients with endoscopically sprayed Shengji hemostat, in order to provide a new method of hemostasis for the treatment of this disease, and to explore the effect of Shengji Zhi Xue powder on the rat model of gastric hemorrhage. Blood mechanism provides pharmacological basis for the clinical application of this prescription. Methods: 1. Clinical study: 60 cases of ANVUGIB patients with hot and forced blood type ANVUGIB were selected from March 2014 to January 2016. The patients were randomly divided into the experimental group (gastroscope spraying Shengji Shengxue powder) and the control group (gastroscope spraying normethylene kidney under the gastroscope). There were 30 cases in each group. The two groups were given pantoprazole acid and nutritional support before the operation. After the patient's life signs were stable, the treatment was given under the gastroscope within 24 hours of bleeding. After endoscopic treatment, the two groups continued to use the same treatment as before the treatment. Observe and record the hemostasis of the two groups of patients under endoscopy. The immediate hemostatic situation in 5min after treatment, the two groups after the treatment of immediate hemostasis rate, fecal occult blood turn negative rate, the mean time of hemostasis, the average time of hospitalization, the total efficiency and other data were observed and compared. Two, the experimental study: 40 rats were randomly divided into blank group (10) and model group (30), model group adopted INDEN The rat model of gastric hemorrhage was replicated by gavage, and the rats were randomly divided into model group (10 rats), positive control group (10 rats), experimental group (10 rats), the experimental group was given Shengji hemostatic powder solution irrigation, the positive control group was given the Yunnan Baiyao solution gavage, the blank group, the model group was given the same amount of physiological saline irrigation, respectively, after the model 0.5h and 3H respectively. Blood was taken from the abdominal aorta after 1.14h intragastric perfusion and the whole stomach was removed. The activation time (APTT), prothrombin time (PT), thrombin time (TT) and gastric mucosa bleeding point were compared in each group. The results were statistically analyzed to explore the hemostatic mechanism of Shengji hemostatic powder. Results: 1, clinical study: immediate hemostasis rate, The immediate hemostasis rate in the experimental group was 96.67%, and the experimental group was superior to the control group (76.67%) (P0.05). The rebleeding rate of the experimental group was 3.33%, the experimental group was significantly lower than the control group (20%) (P0.05). The rate of fecal occult blood conversion was 90%, the test group was significantly higher than the control group (60%) (60%) (P0.05). Time: the average time of hemostasis in the experimental group was 31.43 + 7.67h, the experimental group was significantly lower than the control group (44.20 17.15h) (P0.01). The time of hospitalization was 6.400 + 1.482 D in the experimental group, and the experimental group was significantly shorter than the control group (7.267 + 1.680 D) (P0.05). The total effective rate was 96.67% in the experimental group and the experimental group was clear. Significantly higher than the control group (83.33%) (P0.05) (two), animal experiment: the average PT in the PT: blank group was 11.020 + 1.698 seconds, the model group was 12.650 + 0.642 seconds, the control group was 10.860 + 1.318 seconds, the experimental group was 9.600 + 0.804 seconds, compared with the model group, the blank group, the positive group, and the test group were significantly lower (P0.01); compared with the positive control group, the comparison was compared with the positive control group. The average APTT of the test group was 21.850 + 3.101 seconds, the model group was 25.980 + 3.101 seconds, the model group was 25.980 + 3.602 seconds, the control group was 20.900 + 2.428 seconds, the experimental group was 20.540 + 2.208 seconds. Compared with the model group, the blank group, the positive control group and the test group were significantly reduced (P0.01).TT: blank group TT for 58.650 + 4.880 seconds, the model was 58.650 + 4.880 seconds. The group was 64.810 + 3.704 seconds, the control group was 54.190 + 3.990 seconds, the experimental group was 52.730 + 5.865 seconds. Compared with the model group, the blank group, the positive control group and the test group were all significantly decreased (P0.01). The gastric mucosa bleeding point: the gastric mucosa of the blank group had no bleeding point, 30.400 + 4.858 in the model group, 16.200 + 3.615 in the control group, and 1 in the experimental group. 0.800 + 2.378, compared with the level of gastric mucosal bleeding point in the model group, the blank group, the positive control group and the test group decreased significantly (P0.01). Compared with the level of gastric mucosal bleeding in the positive control group, the experimental group was significantly lower (P0.01). Conclusion: the clinical trial showed that 1. raw muscle hemostasis powder can quickly stop bleeding and improve the stop of ANVUGIB patients. The blood rate, the conversion rate of stool and the total effective rate of treatment.2. Shengji hemostasis powder can shorten the time of hemostasis in ANVUGIB patients and the time of hospitalization,.3. has no adverse reaction after the treatment of Shengji Shengxue powder in this experiment. Animal experiments show that 1. raw muscle hemostasis powder may start the endogenous coagulation and exogenous coagulation in rats, and improve the rat The coagulant function.2. Shengji hemostasis powder can promote the healing of damaged mucosa and reduce the bleeding point of gastric mucosa in rats.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R573.2

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