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目的:探讨奥曲肽联合前列地尔治疗肝硬化并肝肾综合征(hepatorenal syndrome,HRS)的临床疗效.方法:按照随机数字表法将我院消化内科收治的60例肝硬化合并HRS患者均分为试验组和对照组,两组患者均给予常规综合治疗,试验组患者加用奥曲肽注射液联合前列地尔注射液治疗,对照组患者加用前列地尔注射液治疗,比较两组患者治疗前后肾功能指标、血流动力学水平、门静脉内径和脾静脉内径变化情况以及临床疗效.结果:试验组患者治疗后尿素氮(blood urea nitrogen,BUN)和血肌酐(serum creatinine,S C r)水平明显降低,24 h尿量明显增加,与治疗前比较(10.15 mmol/L±5.02 mmol/L vs19.02 mmol/L±7.45 mmol/L、136.13μmol/L±18.62μmol/L vs 211.42μmol/L±17.66μmol/L、1644.36 mL/d±178.30 mL/d,vs443.41 mL/d±77.88 mL/d)差异具有统计学意义(P<0.05);对照组患者治疗后SCr水平明显降低,24 h尿量明显增加,与治疗前比较(152.60μmol/L±16.89μmol/L vs 207.12μmol/L±16.27μmol/L)、(1207.26 mL/d±177.05 mL/d vs 459.51 mL/d±90.37 mL/d),差异具有统计学意义(P<0.05);试验组患者治疗后BUN和SCr水平明显低于对照组(10.15mmol/L±5.02 mmol/L vs 15.72 mmol/L±7.71mmol/L)、(136.13μmol/L±18.62μmol/L vs152.60μmol/L±16.89μmol/L),24 h尿量明显高于对照组,(1644.36 mL/d±178.30 mL/d,vs 1207.26 mL/d±177.05 mL/d)差异具有统计学意义(P<0.05);两组患者治疗前后平均动脉压(mean artery pressure,MAP)、心率(heart rate,HR)水平无明显变化(78.45 mmHg±4.01mmHg vs 76.44 mmHg±4.06 mmHg)、(84.08次/min±4.70次/min vs 86.22次/min±4.67次/min),(78.53 mmHg±4.17 mmHg vs 78.22mmHg±4.08 mmHg)、(84.77次/min±4.34次/min vs 85.55次/min±4.58次/min),差异无统计学意义(P>0.05);两组患者治疗后门静脉内径和脾静脉内径均明显降低,与治疗前比较(11.99 mm±1.33 mm vs 14.02 mm±1.37mm)、(8.16 mm±1.20 mm vs 10.65 mm±1.57mm),(13.05 mm±1.16 mm vs 13.94 mm±1.27mm)、(9.36 mm±1.61 mm vs 10.50 mm±1.61mm),差异具有统计学意义(P<0.05);试验组患者治疗后门静脉内径和脾静脉内径均明显低于对照组(11.99 mm±1.33 mm vs 13.05 mm±1.16 mm)、(8.16 mm±1.20 mm vs 9.36 mm±1.61 mm),差异具有统计学意义(P<0.05);试验组患者显效率和总有效率均明显高于对照组(20.00%vs 6.67%、83.33%vs 46.67%),差异具有统计学意义(P<0.05);两组患者死亡率比较(6.67%vs 6.67%),差异无统计学意义(P>0.05).结论:奥曲肽联合前列地尔能够有效改善肝硬化并HRS患者肾功能、降低门静脉的压力,对患者血流动力学影响小、安全性高,是临床治疗的首选.
Objective: To investigate the clinical efficacy of octreotide combined with alprostadil in the treatment of hepatorenal syndrome (hepatorenal syndrome) .Methods: According to the random number table, 60 patients with cirrhosis and HRS admitted to Department of Gastroenterology, Experimental group and control group, both groups were given conventional comprehensive treatment, the experimental group plus octreotide injection plus alprostadil injection, the control group patients with alprostadil injection treatment, the two groups were compared before and after treatment of renal The indexes of hemodynamics, the diameter of the portal vein and the diameter of the splenic vein, as well as the clinical curative effect.Results The levels of BUN and SCr in the experimental group were significantly lower after treatment , Urine output increased significantly at 24 h after treatment, compared with before treatment (10.15 mmol / L ± 5.02 mmol / L vs 19.02 mmol / L ± 7.45 mmol / L, 136.13 μmol / L ± 18.62 μmol / L vs 211.42 μmol / L ± 17.66 The difference was statistically significant (P <0.05). The level of SCr in the control group was significantly lower after treatment, and the level of urine in 24 h Significantly increased, compared with before treatment (152.60μmol /L ± 16.89μmol / L vs 207.12μmol / L ± 16.27μmol / L), with a significant difference (P <0.05 ). The levels of BUN and SCr in the experimental group were significantly lower than those in the control group (10.15mmol / L ± 5.02mmol / L vs 15.72mmol / L ± 7.71mmol / L), (136.13μmol / L ± 18.62μmol / L vs152). 60 micromol / L ± 16.89 micromol / L), and the urine output of 24 h was significantly higher than that of the control group (1644.36 mL / d ± 178.30 mL / d vs 1207.26 mL / d ± 177.05 mL / d, P < 0.05). Mean arterial pressure (MAP) and heart rate (HR) did not change significantly between the two groups before and after treatment (78.45 mmHg ± 4.01 mmHg vs 76.44 mmHg ± 4.06 mmHg), (84.08 times / min ± 4.70 beats / min vs 86.22 beats / min. 4.67 beats / min, 78.53 mmHg ± 4.17 mmHg vs 78.22 mmHg ± 4.08 mmHg, 84.77 beats / min. 4.34 beats / min vs 85. 55 beats / min. 4.48 beats / min ), The difference was not statistically significant (P> 0.05). After treatment, the diameter of portal vein and the diameter of splenic vein were significantly decreased in both groups (11.99 mm ± 1.33 mm vs 14.02 mm ± 1.37 mm, 8.16 mm ± 1.20 mm vs 10.65 mm ± 1.57 mm), (13.05 mm ± 1.16 mm vs 13.94 mm (9.36 mm ± 1.61 mm vs 10.50 mm ± 1.61 mm), the difference was statistically significant (P <0.05). The diameter of portal vein and splenic vein in experimental group were significantly lower than that in control group (11.99 mm ± 1.27 mm) 1.33 mm vs 13.05 mm ± 1.16 mm respectively), (8.16 mm ± 1.20 mm vs 9.36 mm ± 1.61 mm), the difference was statistically significant (P <0.05). The effective rate and total effective rate in the experimental group were significantly higher than those in the control group (20.00% vs 6.67%, 83.33% vs 46.67%, respectively), the difference was statistically significant (P <0.05). There was no significant difference in mortality between the two groups (6.67% vs 6.67%, P> 0.05). Conclusion: Octreotide combined with alprostadil can effectively improve renal function and reduce the pressure of portal vein in patients with cirrhosis and HRS. It has little effect on hemodynamics and high safety. It is the first choice for clinical treatment.