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目的观察奥曲肽、兰索拉唑单用与联用治疗急性上消化道出血的临床效果。方法选择2011年4月—2013年8月收治的急性上消化道出血患者162例,随机分为奥曲肽组、兰索拉唑组和联合组各54例。所有患者均给予卧床休息、吸氧、禁食、扩容、补液、抗感染、留置胃管等治疗。奥曲肽组加奥曲肽0.1 mg+5%葡萄糖溶液20 ml静脉推注,随后采用奥曲肽0.1 mg+生理盐水50 ml以25μg/h微量泵持续静脉滴注,1次/d。兰索拉唑组加兰索拉唑30 mg+生理盐水100 ml静脉滴注,2次/d。联合组联合应用奥曲肽、兰索拉唑治疗,用法用量分别与奥曲肽组、兰索拉唑组相同。三组均治疗5 d。比较三组患者的止血、住院时间、治疗前后胃液p H值、疗效及不良反应。计量资料比较采用方差分析,组间两两比较采用LSD-t检验,组内比较采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果奥曲肽组止血、住院时间分别为(45.57±6.81)h、(5.43±0.81)d,兰索拉唑组分别为(48.64±8.52)h、(5.62±1.02)d,联合组分别为(32.18±5.84)h、(4.07±0.67)d,联合组与奥曲肽组、兰索拉唑组比较差异均有统计学意义(均P<0.05)。治疗后,奥曲肽组胃液p H值为(4.83±0.52),兰索拉唑组为(4.97±0.61),联合组为(6.17±0.55),联合组与奥曲肽组、兰索拉唑组比较差异均有统计学意义(均P<0.05)。奥曲肽组总有效率为72.22%,兰索拉唑组为68.52%,联合组为87.04%,联合组与奥曲肽组、兰索拉唑组比较差异均有统计学意义(均P<0.05)。奥曲肽组不良反应发生率为3.70%,兰索拉唑组为1.85%,联合组为3.70%,三组不良反应发生率比较差异无统计学意义(P>0.05)。结论奥曲肽、兰索拉唑联合应用治疗急性上消化道出血较单药治疗能明显缩短止血、住院时间,提高胃液p H值,提高临床疗效,且安全可靠,值得在临床上推广应用。
Objective To observe the clinical effect of octreotide and lansoprazole alone and in combination on the treatment of acute upper gastrointestinal bleeding. Methods 162 cases of acute upper gastrointestinal bleeding admitted from April 2011 to August 2013 were randomly divided into octreotide group, lansoprazole group and combination group of 54 cases. All patients were given bed rest, oxygen, fasting, dilatation, rehydration, anti-infection, indwelling gastric tube and other treatment. Octreotide group plus octreotide 0.1 mg + 5% glucose solution 20 ml intravenous injection, followed by octreotide 0.1 mg + saline 50 ml with 25μg / h trace pump continuous intravenous infusion, 1 / d. Lansoprazole group plus lansoprazole 30 mg + saline 100 ml intravenously, 2 times / d. The combined group of octreotide, lansoprazole treatment, dosage and octreotide group, lansoprazole group the same. Three groups were treated for 5 days. The hemostasis, hospitalization time, p H value of gastric juice before and after treatment, curative effect and adverse reactions were compared between the three groups. Measurement data were compared using ANOVA, LSD-t test was used for comparison among groups, paired t test was used in the group, count data were analyzed byχ2 test, P <0.05 was considered statistically significant. Results The hemostasis and hospital stay of octreotide group were (45.57 ± 6.81) h and (5.43 ± 0.81) d, respectively, while those in lansoprazole group were (48.64 ± 8.52) h and (5.62 ± 1.02) days, respectively ± 5.84) h, (4.07 ± 0.67) d respectively. The difference between the combination group and the octreotide group and the lansoprazole group was statistically significant (all P <0.05). After treatment, the p H value of gastric juice in octreotide group was (4.83 ± 0.52), in the lansoprazole group (4.97 ± 0.61), and in the combination group (6.17 ± 0.55), the difference between the combination group and the octreotide group and the lansoprazole group All were statistically significant (P <0.05). The total effective rate was 72.22% in the octreotide group, 68.52% in the lansoprazole group and 87.04% in the combined group. There was significant difference between the combined group and the octreotide group and the lansoprazole group (all P <0.05). The incidence of adverse reactions in octreotide group was 3.70%, in lansoprazole group was 1.85% and in combined group was 3.70%. There was no significant difference in the incidence of adverse reactions between the three groups (P> 0.05). Conclusion Combined application of octreotide and lansoprazole can significantly shorten the time of hemostasis and hospitalization, improve the p H value of gastric juice and improve the clinical curative effect, which is safe and reliable. It is worth to be popularized clinically.