特利加壓素在食管胃底靜脈曲張破裂出血及肝切除術(shù)后的應用
發(fā)布時間：2019-03-29 13:56
【摘要】：第一部分:特利加壓素在食管胃底靜脈曲張破裂出血患者中的應用[目的]:觀察特利加壓素在食管胃底靜脈曲張破裂出血患者中的臨床療效,進而評價治療的有效性、安全性。[方法]:回顧性分析昆明醫(yī)科大學第一附屬醫(yī)院傳染科2016年9月-2017年3月住院的食管胃底靜脈曲張破裂出血患者30例,根據(jù)是否使用特利加壓素將其分為觀察組12例和對照組18例,兩組均采取禁食禁飲、吸氧、輸液、補充血容量等基礎治療,觀察組在此基礎上加用特利加壓素(2mg/4h,出血停止后改為2次/d、1mg/次,連續(xù)使用5d),對照組予生長抑素(首劑250ug靜脈推注,后續(xù)250ug/h持續(xù)泵入,連續(xù)使用5d),觀察比較兩組治療效果及恢復情況。[結(jié)果]:兩組患者在性別組成、年齡、肝腎功能水平、胃底食管靜脈曲張程度、Child-Pugh分級等一般資料方面差異無統(tǒng)計學意義(P0.05);兩組止血時間分別為15.7±1.9h、21.9±3.5h,差異具有統(tǒng)計學意義(P0.05),止血成功分別為11例(91.6%)、16例(88.9%),再出血分別為1例(8.3%)、2例(11.1%),差異無統(tǒng)計學意義(P0.05)。與入院當天比較,兩組治療后門靜脈、脾靜脈內(nèi)徑均有縮小,但觀察組改善較明顯,組間比較:觀察組治療后門靜脈、脾靜脈內(nèi)徑分別為11.±1.0mm、8.1±0.8mm;對照組治療后門靜脈、脾靜脈內(nèi)徑分別為12.1±0.9mm、9.2±0.9mm,兩組間差異均有統(tǒng)計學意義(P0.05)。[結(jié)論]:在治療食管胃底靜脈曲張破裂出血時,特利加壓素在止血時間上優(yōu)于生長抑素,止血率、再出血率二者無明顯差別;特利加壓素在改善門靜脈、脾靜脈內(nèi)徑方面優(yōu)于生長抑素,降低門靜脈壓力作用更顯著。第二部分:特利加壓素對肝切除術(shù)后患者肝腎功能的保護[目的]:觀察特利加壓素在半肝切除后患者中的臨床療效,探討其對肝切除術(shù)后肝腎功能的保護作用,進而評價治療的有效性、安全性。[方法]:回顧性分析昆明醫(yī)科大學第一附屬醫(yī)院器官移植科2016年3月-2017年3月行半肝切除治療的原發(fā)性肝癌患者48例,根據(jù)是否使用特利加壓素將其分為觀察組20例和對照組28例,兩組術(shù)后均予保肝、利尿、補充白蛋白、改善微循環(huán)等基礎治療,觀察組在此基礎上加用特利加壓素(2mg/d持續(xù)泵入,連續(xù)使用5d),觀察比較兩組治療前后臨床指標變化。[結(jié)果]:兩組患者在性別組成、年齡、肝腎功能水平、Child-Pugh分級、病灶大小、術(shù)中情況等一般資料方面差異無統(tǒng)計學意義(P0.05);與術(shù)后第一天比較,兩組患者術(shù)后第3、5天肝腎功能指標、24h尿量、腹腔引流量均有改善,觀察組改善較對照組顯著。組間比較:觀察組術(shù)后3、5天肝腎功能指標分別為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;對照組術(shù)后3、5天肝腎功指標分別為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,兩組間差異均有統(tǒng)計學意義(P0.05)。觀察組術(shù)后3、5 天 24h 尿量分別為 2102.5±142.8ml、2252.8±152.4ml;對照組術(shù)后 3、5 天 24h尿量分別為1964.3±131.8ml、2092.9±103.4ml,兩組間差異均有統(tǒng)計學意義(P0.05)。觀察組術(shù)后3、5天腹腔引流量分別為113.0±8.6ml、35.8±8.8ml;對照組術(shù)后3、5天腹腔引流量分比為131.1±12.9ml、43.9±9.8ml,兩組間差異均有統(tǒng)計學意義(P0.05)。觀察組術(shù)后腹腔引流時間及住院時間分別為5.1±0.8d、7.8±1.2d,對照組術(shù)后腹腔引流時間及住院時間分別為6.6±1.1d、10.9±1.0d,兩組間差異均有統(tǒng)計學意義(P0.05)。[結(jié)論]:特利加壓素能夠減輕半肝切除術(shù)后肝功能損害、減少腹腔積液形成、改善腎功能、縮短腹腔引流時間、住院時間,提高圍手術(shù)期安全性,符合快速康復外科原則。
[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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.3
本文編號：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.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R657.3
【參考文獻】
相關(guān)期刊論文 前10條
1 郭銘花;;肝硬化難治性腹水患者行特利加壓素聯(lián)合前列地爾治療的療效觀察[J];現(xiàn)代消化及介入診療;2016年01期
2 王云溪;歧紅陽;王志民;;奧曲肽聯(lián)合特利加壓素治療肝硬化食管靜脈破裂出血療效觀察[J];中國煤炭工業(yè)醫(yī)學雜志;2015年11期
3 ;急性上消化道出血急診診治流程專家共識[J];中國急救醫(yī)學;2015年10期
4 占國清;李芳;李儒貴;郭鵬;劉翔;張薇薇;譚華炳;;特利加壓素治療肝硬化頑固性腹水合并Ⅱ型肝腎綜合征的療效觀察[J];臨床肝膽病雜志;2015年08期
5 劉桂勤;沈加林;;門靜脈和胃左靜脈內(nèi)徑與肝功能分級及食管胃底靜脈曲張破裂出血的關(guān)系[J];中華實用診斷與治療雜志;2015年07期
6 丁曉紅;顧建英;;特利加壓素治療Ⅱ型肝腎綜合征的臨床療效觀察[J];臨床肝膽病雜志;2015年05期
7 陳祖舜;楊海艦;趙蔭農(nóng);劉劍勇;鄔國斌;黃山;齊魯楠;;特利加壓素在治療肝癌合并肝硬化術(shù)后腹腔積液的療效觀察[J];重慶醫(yī)學;2015年07期
8 楊軍;;注射用特利加壓素治療肝硬化頑固性腹水臨床觀察[J];藥物流行病學雜志;2015年02期
9 張曉勤;黃曉波;李春玲;;特利加壓素在難治性感染性休克中的應用效果觀察[J];實用醫(yī)院臨床雜志;2014年04期
10 孫平;楊勇;鄭啟昌;;特利加壓素對肝切除術(shù)后患者肝腎功能的影響[J];華中科技大學學報(醫(yī)學版);2013年06期
，本文編號：2449613
本文鏈接：http://sikaile.net/yixuelunwen/waikelunwen/2449613.html
最近更新
教材專著
