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目的总结奥曲肽、垂体后叶素、奥美拉唑等联合治疗肝硬化并上消化道出血的疗效。方法对124例确诊的肝硬化并上消化道出血的患者随机分为三组,A组(49例)首次静脉推注奥曲肽100μg,继以奥曲肽25μg/h和垂体后叶素0.05 U/min分两路静脉持续滴注24~96 h,加硝酸甘油0.5 mg,6次/d舌下含化;B组(39例)首次静脉推注6 U垂体后叶素(15 min),继以0.1 U/min速度持续静脉滴注24~96 h,加硝酸甘油0.5 mg,6次/d舌下含化;C组(36例)首次静脉推注奥曲肽100μg,继以25μg/h持续静脉滴注24~96 h。同时常规禁食、口服去甲肾上腺素、留置胃管及输血、补液等支持治疗。用药30 min抽取胃内容物观察胃内出血变化情况。结果三组治疗中止血有效率分别为95.92%、82.05%和61.11%。结论奥曲肽与小剂量垂体后叶素联合治疗肝硬化并上消化道出血止血迅速,效果显著,副作用小,易于推广。单药比较垂体后叶素的止血效果优于奥曲肽,但副作用反之。
Objective To summarize the curative effects of octreotide, pituitrin and omeprazole in the treatment of liver cirrhosis and upper gastrointestinal bleeding. Methods A total of 124 patients with cirrhosis and upper gastrointestinal bleeding were randomly divided into three groups. Group A (49 patients) received the first intravenous injection of 100 μg of octreotide, followed by octreotide 25 μg / h and pituitrin 0.05 U / min Two intravenous infusion of 24 ~ 96 h, plus nitroglycerin 0.5 mg, 6 times / d sublingual; Group B (39 patients) first intravenous injection of 6 U pituitrin (15 min), followed by 0.1 U / min speed continued intravenous infusion of 24 ~ 96 h, plus nitroglycerin 0.5 mg, 6 times / d sublingual; C group (36 patients) first intravenous injection of octreotide 100μg, followed by 25μg / h continuous intravenous infusion 24 ~ 96 h. At the same time conventional fasting, oral norepinephrine, indwelling gastric tube and blood transfusion, rehydration and other supportive treatment. The contents of gastric juice were drawn for 30 min to observe the change of intragastric hemorrhage. Results The effective rate of stopping bleeding in the three groups was 95.92%, 82.05% and 61.11% respectively. Conclusions The combination of octreotide and low dose of vasopressin in the treatment of cirrhosis and upper gastrointestinal bleeding has rapid hemostasis with significant effects and small side effects and is easy to popularize. Hypothalamic compared with pituitrin monotherapy better than octreotide, but vice versa.