Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
Aliment Pharmacol Ther. 2012 Jun;35(11):1267-78. doi: 10.1111/j.1365-2036.2012.05088.x. Epub 2012 Apr 8.
Vasoactive medications such as vasopressin, somatostatin and their analogues (terlipressin, vapreotide and octreotide) are commonly used for the treatment of acute variceal bleeding. However, the risks and benefits of these interventions are not well understood.
To undertake a meta-analysis of the efficacy of vasoactive medications in patients having acute variceal bleeds.
Randomised controlled trials (RCTs) of vasopressin, somatostatin and their analogues, administered to patients with acute variceal bleeds were identified based on systematic searches of nine electronic databases and multiple sources of grey literature.
The search identified 3011 citations, and 30 trials with a total of 3111 patients met eligibility criteria. The use of vasoactive agents was associated with a significantly lower risk of 7-day mortality (RR 0.74; 95% CI 0.57-0.95; P = 0.02; I(2) = 0%; moderate quality of evidence), and a significant improvement in haemostasis (RR 1.21, 95% CI 1.13-1.30; P < 0.001; I(2) = 28%; very low quality of evidence), lower transfusion requirements (pooled mean difference -0.70 units of blood transfused, 95% CI -1.01 to -0.38; P < 0.001; I(2) = 82%; moderate quality of evidence), and a shorter duration of hospitalisation (pooled mean difference -0.71 days; 95% CI -1.23 to -0.19; P = 0.007; I(2) = 0%; low quality of evidence). Studies comparing different vasoactive agents did not show a difference in efficacy, although the quality of evidence was very low.
The use of vasoactive agents was associated with a significantly lower risk of acute all-cause mortality and transfusion requirements, and improved control of bleeding and shorter hospital stay. Studies comparing different vasoactive medications failed to demonstrate a difference in efficacy.
血管活性药物如加压素、生长抑素及其类似物（特利加压素、伐普肽和奥曲肽）常用于治疗急性静脉曲张出血。然而，这些干预措施的风险和益处尚不清楚。
对血管活性药物治疗急性静脉曲张出血患者的疗效进行荟萃分析。
根据系统检索九个电子数据库和多种灰色文献来源，确定了加压素、生长抑素及其类似物治疗急性静脉曲张出血的随机对照试验（RCT）。
搜索共确定了 3011 条引文，30 项试验共 3111 名患者符合入选标准。血管活性药物的使用与 7 天死亡率显著降低相关（RR 0.74；95%CI 0.57-0.95；P=0.02；I²=0%；中等质量证据），且止血效果显著改善（RR 1.21；95%CI 1.13-1.30；P<0.001；I²=28%；极低质量证据），输血需求降低（平均差-0.70 单位输血，95%CI-1.01 至-0.38；P<0.001；I²=82%；中等质量证据），住院时间缩短（平均差-0.71 天；95%CI-1.23 至-0.19；P=0.007；I²=0%；低质量证据）。比较不同血管活性药物的研究并未显示疗效存在差异，尽管证据质量极低。
血管活性药物的使用与急性全因死亡率和输血需求降低、出血控制改善和住院时间缩短显著相关。比较不同血管活性药物的研究未能证明疗效存在差异。
