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      洛賽克聯(lián)合思他寧治療上消化道出血的效果及不良反應(yīng)觀察

      2017-09-22 13:48:59翁燕麗符紅波周燕瓊
      中國(guó)當(dāng)代醫(yī)藥 2017年22期
      關(guān)鍵詞:上消化道出血

      翁燕麗 符紅波 周燕瓊

      [摘要]目的 探討在評(píng)價(jià)洛賽克聯(lián)合思他寧對(duì)于上消化道出血的臨床效果和安全性。方法 2011年1月~2017年1月,我院消化內(nèi)科100例上消化道出血患者隨機(jī)分為觀察組和對(duì)照組,每組各50例。觀察組采用洛賽克聯(lián)合思他寧治療;對(duì)照組采用洛賽克治療。同時(shí),兩組患者均接受禁食、補(bǔ)液以及止血?jiǎng)┑瘸R?guī)保守治療。記錄和比較兩組患者的的住院時(shí)間、住院費(fèi)用、輸血量、急診手術(shù)率、3個(gè)月未愈率以及不良反應(yīng)的發(fā)生率。結(jié)果 觀察組的住院時(shí)間明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義[(6.78±0.74)d vs. (9.62 ±1.26)d](P<0.01);觀察組的住院費(fèi)用明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義[(14361.64±3033.71)元 vs. (18225.80±7249.82)元](P<0.01);觀察組的輸血量明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義[(2.43±1.55)U vs. (3.36±1.68)U](P<0.05);觀察組的急診手術(shù)率明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(4.00% vs. 10.00%)(P<0.05);觀察組的3個(gè)月未愈率明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(4.00% vs. 6.00%)(P<0.05);兩組的不良反應(yīng)發(fā)生率相比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。結(jié)論 洛賽克聯(lián)合思他寧與洛賽克單用相比較,明顯縮短了住院時(shí)間,降低了住院費(fèi)用,減少了輸血量,降低了急診手術(shù)率和3個(gè)月未愈率。

      [關(guān)鍵詞]上消化道出血;洛賽克;思他寧

      [中圖分類號(hào)] R573.2 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721(2017)08(a)-0132-03

      [Abstract]Objective To evaluate the clinical efficacy and safety of Losec combined with Stilamin for upper gastrointestinal bleeding.Methods From January 2011 to January 2017,100 patients with upper gastrointestinal bleeding were randomly divided into observation group and control group.There were 50 cases in each group.The observation group was treated with Losec combined with Stilamin and the control group was treated with Losec alone.At the same time,two groups of patients were received fasting,rehydration and hemostatic agents and other conventional conservative treatment.The hospitalization time,hospitalization cost,blood transfusion,emergency surgery rate,3-month non-cure rate,and adverse events were recorded and compared.Results The hospitalization cost of the observation group was significantly lower than that of the control group,the difference was statistically significant [(6.78±0.74)d vs. (9.62 ±1.26)d](P<0.01);the hospitalization cost of the observation group was significantly lower than that of the control group,the difference was statistically significant[(14361.64±3033.71)yuan vs. (18225.80±7249.82)yuan](P<0.01).The blood transfusion in the observation group was significantly lower than that in the control group [(2.43±1.55)U vs. (3.36±1.68)U](P<0.05).The emergency surgery rate in the observation group was significantly lower than that in the control group (4.00% vs. 10.00%)(P<0.05);The 3-month non-cure rate in the observation group was significantly lower than that in the control group (4.00% vs. 6.00%)(P<0.05);there was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).Conclusion Compared with losecine,the combination of Stilamin and Losec significantly reduced hospital stay,reduced hospitalization costs,reduced blood transfusion,reduced emergency surgery and 3-month non-healing rates.endprint

      [Key words]Upper gastrointestinal bleeding;Losec;Stilamin

      上消化道出血是消化內(nèi)科最常見(jiàn)的危急重癥之一[1-2]。短時(shí)間內(nèi)大量的出血可以導(dǎo)致急性貧血、失血性休克甚至危及患者的生命。臨床上救治上消化道出血的主要方法有禁食、補(bǔ)充血容量、藥物治療、三腔氣囊管壓迫止血、內(nèi)鏡直視下止血、血管介入技術(shù)以及手術(shù)治療[3-4]。洛賽克是一種胃壁細(xì)胞的質(zhì)子泵抑制劑,可抑制胃壁細(xì)胞中的質(zhì)子泵H+-K+-ATP酶,特別是抑制餐后及五肽胃泌素刺激胃酸分泌,從而阻斷胃酸分泌[5-6]。思他寧是生長(zhǎng)抑素,臨床廣泛用于嚴(yán)重急性食道靜脈曲張出血,嚴(yán)重急性胃或十二指腸潰瘍出血,或并發(fā)急性糜爛性胃炎或出血性胃炎[7-8]。近年來(lái),我院消化內(nèi)科采用洛賽克聯(lián)合思他寧治療上消化道出血,取得了一定的療效,現(xiàn)報(bào)道如下。

      1資料與方法

      1.1一般資料

      選取2011年1月~2017年1月我院消化內(nèi)科100例上消化道出血患者。其中,男46例,女54例;年齡17~67歲,平均(47.5±16.45)歲。100例患者均有頭暈、昏厥、心悸、盜汗等臨床癥狀,以及黑便和(或)急性嘔血吐血等臨床表現(xiàn)。所有患者均于最后一次出血24 h內(nèi)接受了胃鏡檢查,胃鏡檢查發(fā)現(xiàn)十二指腸球部潰瘍54例,胃潰瘍28例,復(fù)合性潰瘍16例,Dieulafory病1例,吻合口潰瘍1例。將100例患者隨機(jī)分為觀察組和對(duì)照組,每組各50例。觀察組中男28例,女22例,年齡18~66歲,平均(46.6±17.35)歲,十二指腸球部潰瘍27例,胃潰瘍14例,復(fù)合型潰瘍8例,Dieulafory病1例。對(duì)照組中男18例,女32例;年齡17~67歲,平均(48.4±15.65)歲;十二指腸球部潰瘍27例,胃潰瘍14例,復(fù)合型潰瘍8例,吻合口潰瘍1例。兩組患者年齡、性別、原發(fā)疾病等一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。本研究獲得我院醫(yī)學(xué)倫理委員會(huì)的審查和批準(zhǔn),所有患者均簽署了知情同意書。

      1.2治療方法

      兩組患者均接受了禁食、補(bǔ)液、輸血以及止血?jiǎng)┑瘸R?guī)保守治療。對(duì)照組在常規(guī)保守治療的基礎(chǔ)上予奧美拉唑鎂片(洛賽克,阿斯利康制藥有限公司,國(guó)藥準(zhǔn)字:J20130093)40 mg加入10 ml專用溶媒中,緩慢靜脈注射,2次/d,連用3~5 d。觀察組在對(duì)照組的基礎(chǔ)上予注射用生長(zhǎng)抑素(思他寧,Merck Serono SAAubonne Branch,注冊(cè)證號(hào):H20090929)靜脈給藥,通過(guò)慢速?zèng)_擊注射(3~5 min)250 μg或以250 μg/h的速度連續(xù)滴注給藥。

      1.3觀察指標(biāo)

      經(jīng)治療后,記錄和比較兩組患者的住院時(shí)間、住院費(fèi)用、輸血量以及急診手術(shù)率、3個(gè)月未愈率。除外科手術(shù)病例外,所有患者均于出院3個(gè)月復(fù)查胃鏡,了解出血灶的愈合情況。輸血量以紅細(xì)胞懸液為計(jì)量單位,出院3個(gè)月隨訪胃鏡復(fù)查時(shí)仍發(fā)現(xiàn)原位潰瘍者為未愈。

      1.4統(tǒng)計(jì)學(xué)方法

      采用SPSS 17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析,計(jì)量資料數(shù)據(jù)用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,兩組間比較采用t檢驗(yàn);計(jì)數(shù)資料用率表示,組間比較采用χ2檢驗(yàn),以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。

      2結(jié)果

      2.1兩組患者治療效果的比較

      觀察組的住院時(shí)間明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.01);觀察組的住院費(fèi)用明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.01);觀察組的輸血量明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組的急診手術(shù)率明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組的3個(gè)月未愈率明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)(表1)。

      2.2兩組患者不良反應(yīng)的比較

      觀察組患者不良反應(yīng)發(fā)生率為20.00%(10/50),對(duì)照組為12.00%(6/50),均為惡心嘔吐、食欲下降、頭痛等輕度不良反應(yīng),經(jīng)對(duì)癥治療后消失。兩組患者均未出現(xiàn)肝腎功能損傷、上呼吸道感染等嚴(yán)重不良反應(yīng)和藥物副作用。觀察組和對(duì)照組的不良反應(yīng)發(fā)生率比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)(表2)。

      3討論

      目前臨床上救治上消化道出血的主要方法有:禁食、補(bǔ)充血容量、藥物治療、三腔氣囊管壓迫止血、內(nèi)鏡直視下止血、血管介入技術(shù)以及手術(shù)治療[9]。藥物保守治療具有臨床療效確切、需要的設(shè)備和器材簡(jiǎn)單、臨床操作方便、安全性好、治療費(fèi)用低廉等優(yōu)點(diǎn),尤其在不容易開展三腔氣囊管壓迫止血、內(nèi)鏡直視下止血、血管介入技術(shù)以及手術(shù)治療的廣大基層醫(yī)院,值得作為上消化道活動(dòng)性出血止血的第一選擇,值得在臨床大力推廣應(yīng)用。

      洛賽克是一種胃壁細(xì)胞的質(zhì)子泵抑制劑,可抑制胃壁細(xì)胞中的質(zhì)子泵H+-K+-ATP酶,特別是抑制餐后及五肽胃泌素刺激胃酸分泌,從而阻斷胃酸分泌[10-11]。Worden等[10]的研究結(jié)果顯示,與安慰劑相比較,洛賽克能夠明顯降低空腹以及餐后2 h胃酸的分泌量。思他寧(生長(zhǎng)抑素注射液),臨床廣泛用于嚴(yán)重急性食道靜脈曲張出血,嚴(yán)重急性胃或十二指腸潰瘍出血,或并發(fā)急性糜爛性胃炎或出血性胃炎[12-13],其止血機(jī)制包括:①抑制胃泌素、胃酸和胃蛋白酶的分泌; ②選擇性收縮內(nèi)臟血管。二者起協(xié)同作用,使止血作用肯定而長(zhǎng)久[14-15]。Loudin等[12]的研究結(jié)果顯示,與安慰劑相比較,生長(zhǎng)抑素注射液可以明顯抑制胃泌素、胃酸和胃蛋白酶的分泌水平。

      本研究結(jié)果顯示,觀察組的住院時(shí)間、住院費(fèi)用、輸血量、急診手術(shù)率、3個(gè)月未愈率均明顯低于對(duì)照組。觀察組和對(duì)照組的不良反應(yīng)發(fā)生率相似,差異無(wú)統(tǒng)計(jì)學(xué)意義,提示與洛賽克單用相比較,洛賽克聯(lián)合思他寧臨床療效好,安全性好。

      綜上所述,洛賽克聯(lián)合思他寧與洛賽克單用相比較,明顯縮短了住院時(shí)間,降低了住院費(fèi)用,減少了輸血量,降低了急診手術(shù)率和3個(gè)月未愈率,值得在基層醫(yī)院大力推廣使用。endprint

      [參考文獻(xiàn)]

      [1]Lanas-Gimeno A,Lanas A.Risk of gastrointestinal bleeding during anticoagulant treatment[J].Expert Opin Drug Saf,2017,16(6):673-685.

      [2]Guo X,Wei J,Gao L,et al.Hyperammonemic coma after craniotomy:Hepatic encephalopathy from upper gastrointestinal hemorrhage or valproate side effect?Case report and literature review[J].Medicine(Baltimore),2017,96(15):e6588.

      [3]Ray DM,Srinivasan I,Tang SJ,et al.Complementary roles of interventional radiology and therapeutic endoscopy in gastroenterology[J].World J Radiol,2017,9(3):97-111.

      [4]Ghassemi KA,Jensen DM.What does lesion blood flow tell us about risk stratification and successful management of non-variceal UGI Bleeding?[J]Curr Gastroenterol Rep,2017, 19(4):17.

      [5]Lavie CJ,Howden CW,Scheiman J,Tursi J.Upper gastrointestinal toxicity associated with long-term aspirin therapy:consequences and prevention[J].Curr Probl Cardiol,2017,42(5):146-164.

      [6]Hakim S,Bortman J,Orosey M,et al.Case report and systematic literature review of a novel etiology of sinistral portal hypertension presenting with UGI bleeding:Left gastric artery pseudoaneurysm compressing the splenic vein treated by embolization of the pseudoaneurysm[J].Medicine (Baltimore),2017,96(13):e6413.

      [7]Romano C,Oliva S,Martellossi S,et al.Pediatric gastrointestinal bleeding:perspectives from the italian society of pediatric gastroenterology[J].World J Gastroenterol,2017,23(8):1328-1337.

      [8]Ebrahimi BH,MortezaBagi HR,Rahmani F,et al.Clinical scoring systems in predicting the outcome of acute upper gastrointestinal bleeding:a narrative review[J].Emerg (Teh-ran),2017,5(1):e36.

      [9]Oprita R,Oprita B,Diaconescu B,et al.Upper gastrointestinal endoscopy in emergency setting for patients receiving oral anticoagulants-practice updates[J].J Med Life,2017,10(1):27-32.

      [10]Worden JC,Hanna KS.Optimizing proton pump inhibitor therapy for treatment of nonvariceal upper gastrointestinal bleeding[J].Am J Health Syst Pharm,2017,74(3):109-116.

      [11]Jiang M,Chen P,Gao Q.Systematic review and net-work meta-analysis of upper gastrointestinal hemorrhage interventions[J].Cell Physiol Biochem,2016,39(6):2477-2491.

      [12]Loudin M,Anderson S,Schlansky B.Bleeding“downhill”esophageal varices associated with benign superior vena cava obstruction:case report and literature review[J].BMC Gastroenterol,2016,16(1):134.

      [13]Garber A,Jang S.Novel therapeutic strategies in the management of non-variceal upper gastrointestinal bleeding[J].Clin Endosc,2016,49(5):421-424.

      [14]Naut ER.The approach to occult gastrointestinal bleed[J].Med Clin North Am,2016,100(5):1047-1056.

      [15]Vasapolli R,Malfertheiner P,Kandulski A.Helicobacter pylori and non-malignant upper gastrointestinal diseases[J].Helicobacter,2016,21(Suppl 1):30-33.

      (收稿日期:2017-07-13 本文編輯:馬 越)endprint

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