关键词:

肝硬化, 食管胃底静脉曲张破裂出血, 三腔两囊管, 生长抑素针, 胃肠激素, 血流动力学, 止血效果

Abstract:

Objective　To observe the effect of somatostatin needle + three-lumen and two-balloon catheter on patients with liver cirrhosis complicated with esophageal and gastric variceal bleeding (EGVB). Methods　It was a prospective randomized controlled trial. A total of 65 cirrhosis with EGVB patients admitted to The First Affiliated Hospital of Nanyang Medical College from January 2020 to May 2022 were selected as the research objects. They were divided into an observation group (33 cases) and a control group (32 cases) by the computered random number table method. In the observation group, there were 20 males and 13 females, aged (65.11±0.22) years. In the control group, there were 22 males and 10 females, aged (65.14±0.16) years. The patients in the two groups were treated with three-lumen and two-balloon catheter, and the patients in the observation group were assisted by somatostatin needle. The success rates of hemostasis at different time points after treatment, gastrointestinal hormones and hemodynamic indexes before and after treatment, clinical indexes after treatment, and occurrence of adverse reactions were compared between the two groups. χ² test and independent sample t test were used. Results　Under different treatment regimens, the success rates of hemostasis in the observation group 8, 12, and 24 h after treatment [33.33% (11/33), 60.61% (20/33), and 90.91% (30/33)] were higher than those in the control group [18.75% (6/32), 43.75% (14/32), and 68.75% (22/32)], with statistically significant differences (all P<0.05). Before treatment, there were no statistically significant differences in the levels of growth hormone (SS), gastrin (GAS), and motilin (MLT) between the two groups (all P>0.05). After treatment, the levels of SS [(15.24±0.12) ng/L], GAS [(80.26±0.32) ng/L], and MLT [(211.32±5.16) ng/L] in the observation group were lower than those in the control group [(15.63±0.82) ng/L, (80.65±0.88) ng/L, and (218.41±5.32) ng/L], with statistically significant differences (all P<0.05). Before treatment, there were no statistically significant differences in the central venous pressure (CVP) and portal venous pressure (PVP) between the two groups (both P>0.05). After treatment, the CVP [(9.15±0.27) mmHg (1 mmHg=0.133 kPa)] and PVP [(25.14±0.27) mmHg] in the observation group were lower than those in the control group [(9.58±0.82) mmHg and (25.56±0.85) mmHg], with statistically significant differences (both P<0.05). After treatment, the hemostasis time [(20.25±0.33) min], blood transfusion volume [(266.42±10.45) ml], and rebleeding rate [6.06% (2/33)] in the observation group were all lower than those in the control group [(20.77±0.82) min, (275.33±10.28) ml, and 18.75% (6/32)], with statistically significant differences (all P<0.05). After treatment, there was no statistically significant difference in the incidence of adverse reactions between the observation group [12.12% (4/33)] and the control group [9.38% (3/32)] (P>0.05). Conclusions　In the treatment of liver cirrhosis complicated with EGVB patients by three-lumen and two-balloon catheter, the combined application of somatostatin needle can enhance the hemostatic effect, which has positive significance in further inhibiting the gastrointestinal hormones, improving the hemodynamics, shortening the hemostatic time, reducing the blood transfusion volume, and reducing the risk of rebleeding. The combined application of somatostatin needle does not significantly enhance the risk of adverse reactions, with high safety.

Key words:

Liver cirrhosis, Esophageal and gastric variceal bleeding, Three-lumen and two-balloon catheter, Somatostatin needle,  , Gastrointestinal hormones, Hemodynamics, Hemostatic effect