Efficacy of octreotide combined with thrombin in the treatment of upper gastrointestinal bleeding in schistosomiasis cirrhotic patients / 中华地方病学杂志

ABSTRACT

Objective:To investigate the efficacy of octreotide combined with thrombin in the treatment of upper gastrointestinal bleeding in schistosomiasis cirrhotic patients.Methods:Using prospective design, from January 2017 to January 2019, 86 patients with upper gastrointestinal bleeding caused by schistosomiasis cirrhosis in Binzhou People's Hospital were selected as subjects, aged 34 - 62 years. According to the random number table method, they were divided into control group ( n = 43) and observation group ( n = 43). In two groups, the patients were given 20 U of pituitrin (with a drip rate of 0.4 U/min), after 24 h of treatment, it was changed to a half-dose maintenance, and was stopped after 24 h of bleeding control; 0.1 mg octreotide was used for intravenous injection, continuous intravenous pumping at a rate of 25 μg/h, and continued to pump 2 to 3 days after controlling bleeding. On this basis, the patients in the observation group were perfused with 10 U/ml thrombin. It was implemented once at an interval of 4 hours for 3 days. The clinical efficacy, hemostasis and adverse reactions were compared between the two groups. At the same time, the blood flow of portal vein and splenic vein and liver function indexes [total bilirubin (TBil), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST)] were compared between the two groups after 3 days of treatment. Results:The total effective rate in the observation group (93.02%, 40/43) was significantly higher than that in the control group (76.74%, 33/43, P < 0.05). The hemostatic time, blood transfusion volume and rebleeding rate in the observation group [(19.25 ± 3.28) h, (214.58 ± 42.45) ml, 6.98% (3/43)] were significantly lower than those in the control group [(27.47 ± 3.93) h, (394.66 ± 67.52) ml, 27.91% (12/43), P <0.05]. After 3 days of treatment, the blood flow of portal vein and splenic vein in the observation group [(276.68 ± 54.36), (552.49 ± 67.83) ml/min] were significantly lower than those in the control group [(307.52 ± 59.67), (598.53 ± 73.28) ml/min, P < 0.05]. After 3 days of treatment, the levels of serum TBil, AST and ALT in the observation group [(42.96 ± 8.44) μmol/L, (36.47 ± 6.53) U/L, (31.74 ± 6.39) U/L] were significantly lower than those in the control group [(73.36 ± 9.67) μmol/L, (54.25 ± 8.74) U/L, (50.28 ± 9.26) U/L, P < 0.05]. The total incidence of adverse reactions in the observation group (16.28%, 7/43) was significantly lower than that in the control group (37.21%, 16/43, P < 0.05). Conclusions:Octreotide combined with thrombin is effective in the treatment of upper gastrointestinal bleeding caused by schistosomiasis cirrhosis. It can effectively control bleeding, improve portal vein and splenic vein blood flow and liver function, and has high safety, so it is worthy of clinical promotion.