Abstract Objective To observe the effect of octreotide on esophageal variceal hemorrhage. Methods 50 cases of esophageal variceal bleeding hospitalized patients (both confirmed by endoscopy) were randomly divided into two groups: A group (25 cases) treated with octreotide, B group (25 cases) treated with vasopressin were observed bleeding effect. Results octreotide group 91.5% success rate of hemostasis, the power of vasopressin 62% of the composition. Conclusion Octreotide treatment of esophageal variceal bleeding significantly better than vasopressin.
Key words octreotide; pituitrin; esophageal variceal bleeding
Upper gastrointestinal bleeding is the most common complication of cirrhosis of the liver, especially after esophageal variceal bleeding is difficult to stop the bleeding, the recurrence rate and mortality rate is high, our hospital Octreotide for esophageal variceal bleeding better effect, these are as follows .
1 Materials and Methods
1.1 General information on 50 patients within 24 h before admission hematemesis and (or) black stools, according to clinical manifestation, laboratory examination, B-ultrasound and endoscopy diagnosed as liver cirrhosis and esophageal variceal bleeding. This group of patients, male 34 cases, 16 females, aged 27 to 69 years, mean (50.2 ± 3.2) years old, 32 cases of liver cirrhosis, alcoholic cirrhosis in 15 cases, the other 2 cases. Liver function: Child-PughA grade 14 cases, B grade 28 cases, C grade in 8 cases. Patients were divided into A group (25 cases) and B group (25 patients) in both treatment groups, A group treated with octreotide, B group treated with pituitrin. Two groups in gender, age, bleeding, bleeding before admission average number of causes of bleeding, liver function classification and severity of the disease, etc. There was no significant difference.
1.2 Treatment A: with octreotide (brand name: Sandostatin) 100 μg by adding NS 10ml slow intravenous injection (no less than 5min) after 25 μg / h continuous infusion rate of 48 ~ 72 h. B: to pituitrin 0.4 μg / min continuous infusion, if effective at 12 h, reduced to 0.2 μg / min, maintained 48 h and then reduced to 0.1 μg / min to maintain 48h stop. Pituitrin to combat the adverse effects, while using nitroglycerin 10 ~ 20 μg / min. All patients were fasting, water deprivation 24 ~ 48 h, severe bleeding is still three more balloon catheter hemostasis.
1.3 OUTCOME MEASURES closely observed and recorded symptoms and signs, and adverse effects and the handling, recording before and after treatment of liver and kidney function, electrolytes, blood glucose, blood, urine, stool occult blood test plus, ECG and endoscopy and other tests; monitoring of blood pressure pulse, urine output, vomiting blood volume, stool frequency, volume, color. Bleeding stops indicators: (1) and frequent melena without hematemesis; (2) blood pressure 90/60mmHg above, pulse 60 to 100 times / min, blood pressure and pulse are no longer volatile, bowel sounds normal; (3) Hb, hematocrit no reduction; (4) Endoscopy confirmed the bleeding stops; (5) BUN no rise.
Key words octreotide; pituitrin; esophageal variceal bleeding
Upper gastrointestinal bleeding is the most common complication of cirrhosis of the liver, especially after esophageal variceal bleeding is difficult to stop the bleeding, the recurrence rate and mortality rate is high, our hospital Octreotide for esophageal variceal bleeding better effect, these are as follows .
1 Materials and Methods
1.1 General information on 50 patients within 24 h before admission hematemesis and (or) black stools, according to clinical manifestation, laboratory examination, B-ultrasound and endoscopy diagnosed as liver cirrhosis and esophageal variceal bleeding. This group of patients, male 34 cases, 16 females, aged 27 to 69 years, mean (50.2 ± 3.2) years old, 32 cases of liver cirrhosis, alcoholic cirrhosis in 15 cases, the other 2 cases. Liver function: Child-PughA grade 14 cases, B grade 28 cases, C grade in 8 cases. Patients were divided into A group (25 cases) and B group (25 patients) in both treatment groups, A group treated with octreotide, B group treated with pituitrin. Two groups in gender, age, bleeding, bleeding before admission average number of causes of bleeding, liver function classification and severity of the disease, etc. There was no significant difference.
1.2 Treatment A: with octreotide (brand name: Sandostatin) 100 μg by adding NS 10ml slow intravenous injection (no less than 5min) after 25 μg / h continuous infusion rate of 48 ~ 72 h. B: to pituitrin 0.4 μg / min continuous infusion, if effective at 12 h, reduced to 0.2 μg / min, maintained 48 h and then reduced to 0.1 μg / min to maintain 48h stop. Pituitrin to combat the adverse effects, while using nitroglycerin 10 ~ 20 μg / min. All patients were fasting, water deprivation 24 ~ 48 h, severe bleeding is still three more balloon catheter hemostasis.
1.3 OUTCOME MEASURES closely observed and recorded symptoms and signs, and adverse effects and the handling, recording before and after treatment of liver and kidney function, electrolytes, blood glucose, blood, urine, stool occult blood test plus, ECG and endoscopy and other tests; monitoring of blood pressure pulse, urine output, vomiting blood volume, stool frequency, volume, color. Bleeding stops indicators: (1) and frequent melena without hematemesis; (2) blood pressure 90/60mmHg above, pulse 60 to 100 times / min, blood pressure and pulse are no longer volatile, bowel sounds normal; (3) Hb, hematocrit no reduction; (4) Endoscopy confirmed the bleeding stops; (5) BUN no rise.
2 Results
A group of patients 48 ~ 72 h after the bleeding rate, hospital stay, blood transfusion, mortality rates were lower than B, B group with three-balloon catheter to stop bleeding in 1 case, 1 death, cause of death was esophageal and gastric veins Variceal bleeding caused by rupture of circulatory failure. Adverse reactions: A group of 3 patients had nausea, 2 patients had abdominal distension, B group of 5 patients gripes, 1 gave up treatment, 2 patients to switch to octreotide treatment, 1 case of vasopressin could reduce the pain reduction Endure.
3 Discussion
Upper gastrointestinal bleeding is the most common complication of cirrhosis of the liver, the first hemorrhage, about 70% of patients rebleeding and mortality [1]. Octreotide is a synthetic somatostatin octapeptide derivatives, can selectively reduce the portal vein and collateral blood flow and pressure, so that lower portal pressure without causing changes in blood pressure, but also inhibit gastrin, gastric acid and pepsin Secretion, inhibit pancreatic, gallbladder, intestines, digestive enzyme secretion, bleeding from a direct role for the cause. Octreotide can also increase the lower esophageal sphincter to reduce reflux, to prevent corrosion and rebleeding blood clots, increasing the local contraction of the lower esophageal sphincter pressure and contraction of outer venous plexus venous plexus and the purpose of bleeding [2]. Octreotide stop bleeding quickly, a high success rate and few side effects, early, in adequate doses can shorten the course of treatment and reduce mortality, but the price is higher.
Vein infusion of posterior pituitary Yesu Jing, visceral arteriovenous by contracting to reduce bleeding in portal pressure, but the drug's systemic vasoconstrictor effects often lead to serious cardiovascular complications, often combined with nitroglycerin, their poor health, Elderly patients at high risk or with hypertension, coronary heart disease in elderly patients with limited wider use of bleeding, hemostatic success rate of less than octreotide, withdrawal is easy rebound, adverse drug reactions, but has some hemostatic effect, and the price is cheap.
A group of patients 48 ~ 72 h after the bleeding rate, hospital stay, blood transfusion, mortality rates were lower than B, B group with three-balloon catheter to stop bleeding in 1 case, 1 death, cause of death was esophageal and gastric veins Variceal bleeding caused by rupture of circulatory failure. Adverse reactions: A group of 3 patients had nausea, 2 patients had abdominal distension, B group of 5 patients gripes, 1 gave up treatment, 2 patients to switch to octreotide treatment, 1 case of vasopressin could reduce the pain reduction Endure.
3 Discussion
Upper gastrointestinal bleeding is the most common complication of cirrhosis of the liver, the first hemorrhage, about 70% of patients rebleeding and mortality [1]. Octreotide is a synthetic somatostatin octapeptide derivatives, can selectively reduce the portal vein and collateral blood flow and pressure, so that lower portal pressure without causing changes in blood pressure, but also inhibit gastrin, gastric acid and pepsin Secretion, inhibit pancreatic, gallbladder, intestines, digestive enzyme secretion, bleeding from a direct role for the cause. Octreotide can also increase the lower esophageal sphincter to reduce reflux, to prevent corrosion and rebleeding blood clots, increasing the local contraction of the lower esophageal sphincter pressure and contraction of outer venous plexus venous plexus and the purpose of bleeding [2]. Octreotide stop bleeding quickly, a high success rate and few side effects, early, in adequate doses can shorten the course of treatment and reduce mortality, but the price is higher.
Vein infusion of posterior pituitary Yesu Jing, visceral arteriovenous by contracting to reduce bleeding in portal pressure, but the drug's systemic vasoconstrictor effects often lead to serious cardiovascular complications, often combined with nitroglycerin, their poor health, Elderly patients at high risk or with hypertension, coronary heart disease in elderly patients with limited wider use of bleeding, hemostatic success rate of less than octreotide, withdrawal is easy rebound, adverse drug reactions, but has some hemostatic effect, and the price is cheap.