本文關(guān)鍵詞：生長抑素與奧曲肽對食管胃底靜脈曲張破裂出血患者的臨床對照　出處：《延安大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 生長抑素 奧曲肽 食管靜脈曲張破裂出血

【摘要】：目的:通過回顧性收集進展至肝硬化階段,出現(xiàn)食管胃底靜脈曲張破裂出血的患者,予以不同劑量的生長抑素或者奧曲肽治療,觀察各組患者的止血時間,24h止血率,止血后維持治療三天后停藥后再出血率,用藥期間不良反應(yīng)的發(fā)生例數(shù),并觀察幾組患者的平均住院日、輸血量是否具有差異。方法:共收集70例(男41例、女29例)經(jīng)既往病史、B超、CT、內(nèi)鏡等診斷為肝硬化食管胃底靜脈曲張破裂患者,且患者出血量大(大于1000ml),需要輸血,根據(jù)使用藥物及劑量的不同分為三組:其中A組(26例,年齡47.65±15.1歲,體重58.23±8.52Kg):在給予(奧美拉唑注射劑、止血敏、擴容等)一般治療的基礎(chǔ)上加用生長抑素250ug/h,持續(xù)微泵滴注。B組(23例,年齡48.87±15.56,體重57.87±7.00Kg):在給予(奧美拉唑注射劑、止血敏、擴容等)一般治療的基礎(chǔ)上給予加倍劑量的生長抑素500ug/h,持續(xù)微泵滴注。C組(21例,年齡46.86±14.39歲,體重57.95±6.54Kg):在給予(奧美拉唑注射劑、止血敏、擴容等)一般治療的基礎(chǔ)上給予奧曲肽50ug/h,持續(xù)微泵滴注。分別對三組患者的止血時間、24h止血率,停藥后再出血率,用藥期間不良反應(yīng)發(fā)生率,輸血量,平均住院天數(shù)進行對比,觀察其是否具有統(tǒng)計學(xué)意義。結(jié)果:1.三組入選病例從年齡、體重、血紅蛋白、凝血時間、總蛋白、白蛋白、轉(zhuǎn)氨酶、肌酐、尿素氮等方面進行兩兩比較,P值均大于0.05,無顯著性差異(P0.05),三組患者可以進行兩兩對比。2.A(普通生長抑素)組與B(加倍生長抑素)組相比:在止血時間上的比較,即(21.80±7.01vs 15.6±5.47),P=0.010.05,兩組有顯著差異,加倍生長抑素組患者的止血時間短于普通生長抑素組的患者;兩組在24h止血率上的比較,即(42.3%vs91.3%),由卡方檢驗得出χ2=12.935.97,即p0.0166,故而有統(tǒng)計學(xué)差異,即加倍生長抑素組止血率明顯優(yōu)于普通生長抑素組;兩組在不良反應(yīng)發(fā)生率上的比較,即(7.6%vs4.35%),由卡方檢驗得出χ2=0.0265.97,則p0.0166,兩者無顯著性差異,即普通生長抑素組與加倍生長抑素組患者的不良反應(yīng)未見明顯差異;停藥3天后再出血率,兩組患者中,停藥后均未見再出血患者;兩組在平均輸血量上的比較,即(594.23±301.77vs310.87±116.73),p=0.0100.05,兩組有顯著差異,即加倍生長抑素組患者的輸血量明顯低于普通生長抑素組的患者;兩組在平均住院日上的比較,即(20.53±3.07vs11.43±1.99),p=0.0420.05,兩組有顯著差異,即加倍生長抑素組患者的平均住院日明顯低于普通生長抑素組。3.a(普通生長抑素)組與c(奧曲肽)組的比較:在止血時間上的比較,即(21.80±7.01vs15.38±6.19),p=0.030.05,兩組有顯著差異;兩組在24h止血率上的比較,即(42.3%vs85.7%),由卡方檢驗得出χ2=9.265.97,即p0.0166,故而有統(tǒng)計學(xué)差異,普通生長抑素組止血率不優(yōu)于奧曲肽組;兩組在不良反應(yīng)發(fā)生率上的比較,即(7.6%vs4.8%),由卡方檢驗得出χ2=0.0365.97,則p0.0166,兩者無顯著性差異;停藥3天后再出血率,兩組患者中停藥后均未見再出血患者;兩組在輸血量上的比較,即(594.23±301.77vs397.62±223.31),p=0.0220.05,兩組有顯著差異;兩組在平均住院日上的比較,即(20.53±3.07vs14.00±1.84),p=0.0470.05,兩組有顯著差異。4.b(加倍生長抑素)組與c(奧曲肽)組在止血時間上的比較,在止血時間上的比較,即(15.6±5.47vs15.38±6.19),p=0.89800.05,兩組無明顯差異;兩組在24h止血率上的比較,即(91.3%vs85.7%),由卡方檢驗得出χ2=0.0125.97,則p0.0166,故而無統(tǒng)計學(xué)差異,兩組的止血率無明顯區(qū)別;兩組在不良反應(yīng)發(fā)生率上的比較,即(4.35%vs4.8%),由卡方檢驗得出χ2=0.435.97,則p0.0166,兩者無顯著性差異;停藥3天后再出血率,兩組患者中,停藥后均未見再出血患者;兩組在輸血量上的比較,即(310.87±116.73vs397.62±223.31),p=0.3230.05,兩組無明顯差異;兩組在平均住院日上的比較,即(11.43±1.99vs14.00±1.84),p=0.7410.05,兩組無明顯差異。結(jié)論:加倍劑量的生長抑素與奧曲肽組在止血時間上無明顯差異,而其二者的止血時間均短于普通生長抑素組;加倍劑量的生長抑素與奧曲肽組在的止血率上無明顯差異,而其二者的止血率均優(yōu)于普通生長抑素組;在不良反應(yīng)發(fā)生率中,三者均未見明顯差異;三組患者中停藥后均未見再出血患者;在平均輸血量上,加倍劑量的生長抑素組與奧曲肽組相比,無特異性差異,然兩者的輸血量均少于普通生長抑素組;平均住院日的比較中,加倍劑量的生長抑素組與奧曲肽組無顯著差異,但其二者的平均時間均短于普通生長抑素組。綜上可知,加倍劑量的生長抑素組與奧曲肽組在止血時間、止血率、輸血量、平均住院日上未見明顯差異,且均優(yōu)于普通生長抑素組,可優(yōu)先選用于臨床。三種藥物在止血后維持靜滴三天后停藥,均可預(yù)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.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R575.2

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