Avgerinos A, Armonis A, Raptis S
2nd Dept. of Gastroenterology, Evangelismos Hospital, Athens University, Greece.
Hepatogastroenterology. 1995 Apr;42(2):145-50.
In recent years, somatostatin and its long-acting analogue octreotide have been used as the initial treatment in acute variceal hemorrhage, with conflicting results. The aim of this study was to meta-analyse all the randomised controlled trials published in English, in which somotostatin or octreotide was compared with other vasoactive drugs, balloon tamponade and endoscopic sclerotherapy in variceal hemorrhage. Concerning the control of bleeding, somatostatin or octreotide therapy was shown to be significantly better than the other vasoactive drugs (p < 0.0012, x2 = 10.55). In contrast, the effectiveness of both agents appeared to be similar to that of balloon tamponade and sclerotherapy in arresting acute variceal hemorrhage during the infusion period. Regarding the complication rate, it appears that treatment with somatostatin or octreotide is followed by a significantly lower complication rate as compared with the other vasoactive drugs (p < 0.0001, x2 = 16.47) as well as than endoscopic sclerotherapy (p, 0.0002, x2 = 14.16). In conclusion, the results of this study suggest that in acute variceal hemorrhage, somatostatin or octreotide is better than any other combination of vasoactive drugs. As regards comparison with sclerotherapy or balloon tamponade, further evidence of benefit is needed before a recommendation can be made for the use of instead of these two kind of treatments of the former procedures.
近年来，生长抑素及其长效类似物奥曲肽已被用作急性静脉曲张出血的初始治疗药物，但其结果存在争议。本研究的目的是对所有以英文发表的随机对照试验进行荟萃分析，这些试验比较了生长抑素或奥曲肽与其他血管活性药物、气囊压迫术及内镜硬化疗法在静脉曲张出血治疗中的效果。在出血控制方面，生长抑素或奥曲肽治疗显示明显优于其他血管活性药物（p < 0.0012，x2 = 10.55）。相比之下，在输注期间，这两种药物在止血方面的效果似乎与气囊压迫术和硬化疗法相似。关于并发症发生率，与其他血管活性药物相比，生长抑素或奥曲肽治疗后的并发症发生率显著更低（p < 0.0001，x2 = 16.47），与内镜硬化疗法相比也是如此（p < 0.0002，x2 = 14.16）。总之，本研究结果表明，在急性静脉曲张出血中，生长抑素或奥曲肽比其他任何血管活性药物组合都更好。至于与硬化疗法或气囊压迫术的比较，在能够推荐使用前者替代这两种治疗方法之前，还需要更多的有益证据。
