Freitas D S, Sofia C, Pontes J M, Gregório C, Cabral J P, Andrade P, Rosa A, Camacho E, Ferreira M, Portela F, Romãozinho J M, Tomé L, Gouveia H, Leitão M, Pimenta I, Donato A
Gastroenterology Department, Coimbra University Hospital, Portugal.
Hepatogastroenterology. 2000 Sep-Oct;47(35):1310-4.
BACKGROUND/AIMS: To assess the value of octreotide in the control of acute bleeding esophageal varices, in a prospective randomized study.
One hundred and ninety-seven patients admitted for variceal bleeding confirmed at endoscopy were recruited and divided into two groups: group I (n = 111) with endoscopic stigmata of recent bleeding; and group II (n = 86) with active bleeding at emergency endoscopy. Patients in group I were randomized to receive a continuous infusion of octreotide (n = 58) or emergency sclerotherapy (n = 53). Patients in group II were assigned to sclerotherapy (n = 42) or to sclerotherapy plus octreotide (n = 44). At the end of the period of study (48 hours), patients were submitted to sclerotherapy or band ligation until variceal obliteration was achieved.
In group I, octreotide was found to be as effective as sclerotherapy regarding hemostasis at 48 hours and on day 7 after the index bleeding episode. Transfusion needs were not significantly different for the two treatment modalities. In group II, the association of octreotide with sclerotherapy was significantly better than sclerotherapy alone either in controlling acute active bleeding (P < 0.001) or in achieving hemostasis at 48 hours (P < 0.01). Transfusion needs were significantly fewer in patients treated with this therapeutic association as compared to sclerotherapy alone.
These results suggest that octreotide infusion is effective in the treatment of variceal bleeding. In patients with recent bleeding, octreotide infusion is as effective as emergency sclerotherapy. In active variceal bleeding, it is a valuable adjuvant treatment in association with emergency sclerotherapy.
背景/目的：在一项前瞻性随机研究中评估奥曲肽在控制急性食管静脉曲张出血方面的价值。
招募了197例经内镜检查确诊为静脉曲张出血的患者，并将其分为两组：第一组（n = 111）有近期出血的内镜下表现；第二组（n = 86）在急诊内镜检查时有活动性出血。第一组患者随机接受奥曲肽持续输注（n = 58）或急诊硬化治疗（n = 53）。第二组患者被分配接受硬化治疗（n = 42）或硬化治疗加奥曲肽（n = 44）。在研究期结束时（48小时），对患者进行硬化治疗或套扎术，直至静脉曲张闭塞。
在第一组中，发现奥曲肽在48小时及首次出血事件后第7天的止血效果与硬化治疗相当。两种治疗方式的输血需求无显著差异。在第二组中，奥曲肽与硬化治疗联合使用在控制急性活动性出血（P < 0.001）或在48小时实现止血（P < 0.01）方面均明显优于单独的硬化治疗。与单独的硬化治疗相比，接受这种联合治疗的患者输血需求明显更少。
这些结果表明奥曲肽输注在治疗静脉曲张出血方面是有效的。在近期出血的患者中，奥曲肽输注与急诊硬化治疗效果相当。在活动性静脉曲张出血中，它是与急诊硬化治疗联合使用的有价值的辅助治疗方法。
