Jenkins S A, Kingsnorth A N, Ellenbogen S, Copeland G, Davies N, Sutton R, Shields R
University Department of Surgery, Royal Liverpool University Hospital, UK.
HPB Surg. 1996;10(1):1-6. doi: 10.1155/1996/39486.
Bleeding from oesophageal varices, oesophageal ulcers or oesophagitis is occasionally massive and difficult to control. Octreotide, a synthetic analogue of somatostin lowers portal pressure and collateral blood flow including that through varices, increases lower oesophageal sphincter pressure, and inhibits the gastric secretion of acid as well as pepsin. Our current experience suggests it is effective in controlling acute variceal haemorrhage. Therefore we have examined the efficacy of octreotide in the control of post-sclerotherapy bleeding from oesophageal varices, oesophageal ulcers and oesophagitis. During the study period 77 patients experienced a significant gastrointestinal bleed (blood pressure < 100 mm Hg, pulse > 100 beats per min or the need to transfuse 2 or more units of blood to restore the hemoglobin level) following injection sclerotherapy of oesophageal varices. The source of bleeding was varices in 42 patients, oesophageal ulcers in 31 and oesophagitis in 4. All patients received a continuous intravenous infusion of octreotide (50 micrograms/h) for between 40-140h. If bleeding was not controlled in the first 12h after commencing octreotide hourly bolus doses (50 micrograms) for 24h were superimposed on the continuous infusion. Haemorrhage was successfully controlled by an infusion of octreotide in 38 of the 42 patients with bleeding from varices, in 30 of 31 patients with oesophageal ulceration, and all patients with oesophagitis. In the 1 patient with persistent bleeding from oesophageal ulceration and in 2 of the 4 with continued haemorrhage from varices, haemostasis was achieved by hourly boluses of 50 micrograms octreotide for 24h in addition to the continuous infusion. No major complications were associated with octreotide administration. The results of this study clearly indicate that octreotide is a safe and effective treatment for the control of severe haemorrhage after technically successful injection of sclerotherapy.
食管静脉曲张、食管溃疡或食管炎引起的出血偶尔会很严重且难以控制。奥曲肽是一种生长抑素的合成类似物，可降低门静脉压力和包括通过静脉曲张的侧支血流，增加食管下括约肌压力，并抑制胃酸和胃蛋白酶的分泌。我们目前的经验表明它在控制急性静脉曲张出血方面是有效的。因此，我们研究了奥曲肽在控制食管静脉曲张、食管溃疡和食管炎硬化治疗后出血方面的疗效。在研究期间，77例患者在食管静脉曲张注射硬化治疗后发生了严重的胃肠道出血（血压<100mmHg，脉搏>100次/分钟或需要输注2个或更多单位的血液以恢复血红蛋白水平）。出血来源为静脉曲张42例，食管溃疡31例，食管炎4例。所有患者均接受奥曲肽持续静脉输注（50微克/小时）40至140小时。如果在开始奥曲肽治疗后的前12小时内出血未得到控制，则在持续输注的基础上叠加24小时的每小时推注剂量（50微克）。42例静脉曲张出血患者中有38例、31例食管溃疡患者中有30例以及所有食管炎患者通过奥曲肽输注成功控制了出血。在1例食管溃疡持续出血的患者和4例静脉曲张持续出血的患者中的2例中，除了持续输注外，通过每小时推注50微克奥曲肽24小时实现了止血。奥曲肽给药未出现重大并发症。这项研究的结果清楚地表明，奥曲肽是一种安全有效的治疗方法，可用于在技术上成功进行硬化治疗后控制严重出血。
