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目的 :观察垂体后叶素联合酚妥拉明治疗肝硬化食管胃底静脉曲张破裂出血的临床疗效和门脉系统血液动力学的变化 ,并与施他宁比较。方法 :72例随机分成两组 :A组 37例 ,给予垂体后叶素 12U +生理盐水 4 0ml静注 ,后以 6 0U +酚妥拉明 10mg + 10 %葡萄糖 5 0 0ml维持 12h静滴 ,连续给药 3d。B组 35例 ,首次给予施他宁 0 .2 5mg静注 ,后持续静滴 0 .2 5mg/h ,连续用药 3天。治疗前后于空腹静息状态下彩色多普勒超声探查门脉系统。结果 :A、B两组总止血率分别为 75 .6 8%和 82 .86 % ,无显著性差异 ,P >0 .0 5。两组在治疗后门静脉、脾静脉和肠系膜上静脉内径与治疗前相比明显缩小 ,P <0 .0 0 1;而门静脉和脾静脉血流速度显著增加 ,P <0 .0 0 1;肠系膜上静脉血流速度治疗前后无明显变化 ,P >0 .0 5 ;治疗后门静脉、脾静脉和肠系膜上静脉血流量与治疗前相比显著减少 ,P <0 .0 0 1。结论 :垂体后叶素联合酚妥拉明治疗肝硬化食管胃底静脉曲张破裂出血的临床疗效与施他宁基本相似 ,都具有减少门脉血流量 ,降低门脉压力的作用。垂体后叶素联合酚妥拉明是治疗肝硬化食管胃底静脉曲张破裂出血的首选方法。
Objective: To observe the clinical efficacy of vasopressin combined with phentolamine in the treatment of hepatic cirrhosis with esophageal variceal bleeding and portal system hemodynamics changes, and compared with the somatostatin. Methods: Seventy-two patients were randomly divided into two groups: group A (n = 37), pituitrin 12U + saline 40ml, intravenous infusion of 60U + phentolamine 10mg + 10% glucose 500ml for 12h, Continuous administration 3d. B group 35 cases, for the first time given Shitaining 0. 25mg intravenous infusion, continuous infusion of 0. 25mg / h, continuous medication for 3 days. Color Doppler ultrasound probe portal system in fasting and resting state before and after treatment. Results: The total hemostasis rates of group A and group B were 75.68% and 82.86% respectively, with no significant difference (P> 0.05). After treatment, the diameter of portal vein, splenic vein and superior mesenteric vein were significantly reduced in both groups compared with that before treatment (P <0.01), while the portal and splenic venous blood flow velocity increased significantly, P <0.01; mesentery There was no significant difference between the two groups (P> 0.05). The blood flow of portal vein, splenic vein and superior mesenteric vein decreased significantly after treatment, P <0.01. Conclusion: The clinical efficacy of vasopressin combined with phentolamine in the treatment of patients with esophageal and gastric variceal bleeding due to cirrhosis of the liver is similar to that of doxycycline, which has the effects of reducing portal blood flow and decreasing portal pressure. Pituitrin combined with phentolamine is the treatment of cirrhosis and esophageal varices bleeding the preferred method.