目的 對(duì)照觀察肝硬化急性食管胃靜脈曲張出血（EVB）常用治療藥物生長(zhǎng)抑素、特利加壓素及其聯(lián)合治療與加用或不加用抗生素等不同策略的療效。方法 選取聯(lián)勤保障部隊(duì)第九〇〇醫(yī)院收治的肝硬化食管胃靜脈曲張首次破裂急性出血的患者97例，根據(jù)用藥不同分為對(duì)照組（39例，生長(zhǎng)抑素治療）和治療組（58例，生長(zhǎng)抑素聯(lián)合特利加壓素治療）。對(duì)照組應(yīng)用十四肽生長(zhǎng)抑素250~500 μg/h持續(xù)靜脈泵入；治療組在對(duì)照組基礎(chǔ)上加用特利加壓素4~6 mg/d，持續(xù)靜脈泵入，活動(dòng)性出血控制后，特利加壓素改為2 mg/d持續(xù)靜脈泵入。觀察兩組患者止血成功率、止血時(shí)間、再出血率及死亡率的差異。并將兩組患者中是否加用抗生素進(jìn)行亞組分析，對(duì)比兩種治療策略中加用抗生素對(duì)急性食管胃靜脈曲張出血的止血效果及患者生存率的影響。結(jié)果 （1）兩種治療策略療效比較：治療組與對(duì)照組比較，止血成功率（75.86%vs 56.41%，χ²=4.058，P=0.044），止血所需時(shí)間[（4.3±2.0）d vs（5.5±2.6）d，t=2.297，P=0.024]和再出血率（5.17%vs 20.51%，2χ=5.458，P=0.025）差異均具有統(tǒng)計(jì)學(xué)意義。但兩組患者死亡率（18.97%vs 12.82%，χ²=0.639，P=0.424）比較差異無統(tǒng)計(jì)學(xué)意義。（2）抗生素對(duì)EVB治療效果的影響：在對(duì)照組中加抗生素與未加抗生素組相比，止血成功率（63.16%vs 50.00%，χ²=0.686，P=0.408）、止血時(shí)間[（5.2±2.9）d vs（5.9±2.0）d，t=-0.740，P=0.465]和再出血率（15.79%vs 25.00%，χ²=0.507，P=0.695）差異均無統(tǒng)計(jì)學(xué)意義，但兩組患者死亡率（0.00%vs 25.00%，χ²=5.449，P=0.047）差異具有統(tǒng)計(jì)學(xué)意義；在治療組中加抗生素與未加抗生素組相比止血成功率（78.72%vs 63.64%，χ²=1.108，P=0.433），再出血率（6.38%vs 0.00%，χ²=0.740，P=1.000）和死亡率（14.89%vs 36.36%，χ²=2.674，P=0.102）差異均無統(tǒng)計(jì)學(xué)意義，但兩組患者的止血時(shí)間[（4.1±1.8）d vs（5.7±2.4）d，t=-2.045，P=0.047]差異具有統(tǒng)計(jì)學(xué)意義。結(jié)論 生長(zhǎng)抑素聯(lián)合特利加壓素治療肝硬化急性食管胃靜脈曲張出血患者的止血成功率、止血時(shí)間、再出血發(fā)生率均優(yōu)于生長(zhǎng)抑素單藥治療組，因此認(rèn)為生長(zhǎng)抑素聯(lián)合特利加壓素是目前急性食管胃靜脈曲張出血相對(duì)較好的治療策略；抗生素在生長(zhǎng)抑素單藥治療組和生長(zhǎng)抑素與特利加壓素聯(lián)合治療組中得出的結(jié)果不一致，抗生素在肝硬化EVB治療中的作用和價(jià)值尚不確定。

Objective to investigate the therapeutic effects of somatostatin alone or somatostatin combined with terlipressin, each with or without the use of antibiotics, on esophageal and gastric variceal bleeding in patients with cirrhosis; To further optimize the non-invasive treatment strategy for EVB caused by liver cirrhosis. Methods A total of ninety-seven cases of acute hemorrhage of esophageal gastric varices with cirrhosis were collected in 900 Hospital of the Joint Logistics Team. They were divided into two groups, as somatostatin treatment group (n=39), somatostatin combined with terlipressin (n=58). Somatostatin treatment group received somatostatin 250-500 μg/h by continuous intravenous infusion. The combined treatment group received fourteen peptide somatostatin and terlipressin at a dose of 4-6 mg/d simultaneously by continuous intravenous infusion. When the bleeding was ceased, terlipressin dosing was adjusted to 2 mg/d. The hemostasis rate, hemostasis time, re-bleeding rate and mortality rate were analyzed.Sstratified analysis based on the use of antibiotics for hemostasis rate of esophageal gastric bleeding and survival rate were conducted. Results (1) Comparison of the efficacy of two treatment strategies:combined treatment group and somatostatin monotherapy group compared the success rate of hemostasis (75.86% vs 56.41%, χ²=4.058, P=0.044), hemostasis time[(4.3±2.0) d vs 5.5±2.6) d, t=2.297, P=0.024] and rebleeding rate (5.17% vs 20.51%, χ²=5.458, P=0.025). Differences were with statistical significance. There was no statistical difference between the two groups of patient mortality (18.97% vs 12.82%, χ²=0.639, P=0.424). (2) The effect of antibiotics on the treatment of EVB:with antibiotics in somatostatin treatment group compared with non antibiotic group success rate of hemostasis (63.16% vs 50%, χ²=0.686, P=0.408), bleeding time[(5.2±2.9) d vs 5.9±2.0) d, t=-0.740, P=0.465] and rebleeding rate (15.79% vs 25%, χ²=0.507, P=0.695) were not statistically significant. But the difference of the mortality rate of patients in the two groups (0% vs 25% χ²=5.449, P=0.047), were statistically significant; With antibiotics in the combination therapy group compared with non antibiotic group hemostasis success rate (78.72% vs 63.64%, χ²=1.108, P=0.433), rebleeding rate (6.38% vs 0%, χ²=0.740, P=1.000) and mortality (14.89% vs 36.36%, χ²=2.674, P=0.102) had no statistical significance. But the two groups of patients with bleeding time[(4.1±1.8)d vs (5.7±2.4) d, t=-2.045, P=0.047] the difference was statistically significant. Conclusion The success rate of hemostasis, hemostasis time, rebleeding occurrence rate of somatostatin combined terlipressin in treating liver cirrhotic patients with acute esophageal and gastric variceal bleeding were better than the single drug treatment with somatostatin, somatostatin combined with terlipressin group is currently better treatment strategies for acute esophageal and gastric variceal hemorrhage. The effeccts of antibiotics in somatostatin group and somatostatin combined with terlipressin group obtained inconsistent results, so the effeccts of antibiotics in the treatment of cirrhosis of the liver and EVB in this study is yet to be ascertained.

R975;R978.7

福建省社會(huì)發(fā)展引導(dǎo)性重點(diǎn)項(xiàng)目（2016Y0068）