摘要
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 pituitrin combined with phentolamine in treating patients with gastroesophageal variceal hemorrhage as well as the hemodynamics changes of portal vein system. Methods: 72 patients were randomly divided into two groups: 37 patients in group A were treated with pituitrin 12U +normal saline 40ml intravenously first, then pituitrin 60U + phentolamine 10 mg in 10% glucose 500ml drip for 12 h× 3 days. 35 patients in group B were started with stilamin 0.25 mg intravenously, followed by stilamin 0.25mg/h for 3 days. Portal hemodynamics related parameters were explored with color Doppler ultrasonography before and after treatment. Results: The total hemostatic rates of group A and B were 75.68% and 82.86% respectively. There was no significant difference, P>0.05; The diameters of portal vein, splenic vein and superior mesenteric vein after the treatment were smaller than that of before treatment in both groups, P <0.001. The flow velocity of portal vein and splenic vein after treatment increased than that of before treatment ( P <0.001), but that of superior mesenteric vein had no marked changes ( P >0.05); Their blood flow volumes after treatment were lower than that of before treatment ( P <0.001). Conclusions: The clinical efficacy of pituitrin combined with phentolamine for patients with gastroesophageal variceal hemorrhage was similar to that of stilamin. They both play a role in reducing the pressure and blood flow volume of portal system. The therapy of pituitrin combined with phentolamine may be the first choice in out patients and emergency department for treament of variceal bleeding.
出处
《内科急危重症杂志》
2003年第4期191-193,共3页
Journal of Critical Care In Internal Medicine
