艾司奥美拉唑镁联合白眉蛇毒血凝酶对非静脉曲张性上消化道出血的治疗效果观察

doi:10.3969/j.issn.1674-8115.2022.11.009

摘要/Abstract

摘要：

目的·观察艾司奥美拉唑镁联合白眉蛇毒血凝酶治疗非静脉曲张性上消化道出血（upper gastrointestinal hemorrhage，UGH）的临床总有效率及对患者上消化道黏膜、炎性反应、应激反应、血液流变学的影响。方法·采用随机数字表，将于2020年3月~2021年3月由四川大学华西空港医院收治的146例急性UGH患者分为联合组与对照组，各73例。在常规治疗基础上，对照组给予艾司奥美拉唑镁治疗，联合组给予艾司奥美拉唑镁联合白眉蛇毒凝血酶治疗。治疗5 d后比较2组的临床总有效率，以及治疗前后2组患者的血清相关因子［血清前列腺素 $E 2$ （prostaglandin $E 2$ ，PGE₂）、6-酮前列腺素F_1α（6-keto prostaglandin F_1α，6-Keto-PGF_1α）］、应激指标［一氧化氮（NO）、皮质醇（cortisol，COR）、胃泌素（gastrin，GAS）］、血清炎性因子［C反应蛋白（C-reactive protein，CRP）、白细胞介素-6（interleukin-6，IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）］及血液流变学指标［全血高切黏度、全血低切黏度、红细胞沉降率（erythrocyte sedimentation rate，ESR）、红细胞比容（packed cell volume，PCV）］的变化。结果·联合组临床总有效率（95.89%）高于对照组（86.30%）（P=0.042）。治疗5 d后，联合组应激指标（NO、COR、GAS）水平、血清炎症因子（CRP、IL-6、TNF-α）水平、ESR及6-Keto-PGF_1α水平均低于对照组（均P=0.000）；联合组全血高切黏度、全血低切黏度、PCV、PGE₂水平均高于对照组（均P=0.000）。结论·艾司奥美拉唑镁联合白眉蛇毒血凝酶治疗UGH临床效果显著，作用机制可能与其能降低机体应激反应和炎症反应、改变血液流变学、保护上消化道黏膜等作用有关。

关键词: 上消化道出血, 白眉蛇毒血凝酶, 艾司奥美拉唑镁, 临床效果

Abstract:

Objective ·To observe the total clinical effective rate of esomeprazole magnesium combined with hemocoagulase in the treatment of upper gastrointestinal hemorrhage (UGH) and its influence on upper gastrointestinal mucosa, inflammatory response, stress response and hemorheology. Methods ·A total of 146 patients with UGH, admitted to West China Airport Hospital, Sichuan University from March 2020 to March 2021, were divided into combined group and control group by using the random number table method, with 73 cases in each group. On the basis of conventional treatment, patients in the control group were treated with esomeprazole magnesium, and patients in the combined group were given esomeprazole magnesium combined with hemocoagulase. The total clinical effective rate after 5 d of treatment, as well as serum related factors [serum prostaglandin E₂ (PGE₂), and 6-keto-prostaglandin F_1α (6-Keto-PGF_1α)], stress indicators [nitric oxide (NO), cortisol (COR), and gastrin (GAS)], serum inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α)] and hemorheological indicators [whole blood high-shear viscosity, whole blood low-shear viscosity, erythrocyte sedimentation rate, and hematocrit] before and after treatment were compared between the two groups. Results ·The total clinical effective rate of 95.89% in the combined group was higher than 86.30% in the control group (P=0.042). After 5 d of treatment, the stress indicator (NO, COR, and GAS) levels, serum inflammatory factors (CRP, IL-6, and TNF-α), erythrocyte sedimentation rate, and 6-Keto-PGF_1α in the combined group were lower than those in the control group (all P=0.000). The whole blood high-shear viscosity, whole blood low-shear viscosity, hematocrit and PGE₂ levels were higher in the combined group compared to the control group (all P=0.000). Conclusion ·The clinical effect of esomeprazole magnesium combined with hemocoagulase is significant in the treatment of UGH, which may be related to the effect of reducing body′s stress response and inflammatory response, changing hemorheology and protecting upper gastrointestinal mucosa.

Key words: upper gastrointestinal hemorrhage, hemocoagulase, esomeprazole magnesium, clinical effect

中图分类号:

R573.2

唐闯, 张鑫, 张婷. 艾司奥美拉唑镁联合白眉蛇毒血凝酶对非静脉曲张性上消化道出血的治疗效果观察[J]. 上海交通大学学报（医学版）, 2022, 42(11): 1576-1581.

TANG Chuang, ZHANG Xin, ZHANG Ting. Treatment effect of esomeprazole magnesium combined with hemocoagulase on upper gastrointestinal hemorrhage[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2022, 42(11): 1576-1581.

图/表 6

参考文献 18

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Item	Joint group （n=73）	Control group （n=73）	t/χ² value	P value
Gender/n （%）			0.111	0.739
Male	42 （57.5）	40 （54.8）
Female	31 （42.5）	33 （45.2）
Age/year	38.56±7.83	39.12±7.62	0.438	0.662
Cause of hemorrhage/n （%）			1.335	0.721
Erosive gastritis	19 （26.0）	17 （23.3）
Gastric ulcer	15 （20.6）	21 （28.8）
Digestive tract tumor	16 （21.9）	14 （19.2）
Duodenal ulcer	23 （31.5）	21 （28.8）
Antithrombotic drug therapy/n （%）			1.043	0.307
Yes	31 （42.5）	25 （34.2）
No	42 （57.5）	48 （65.8）
Modified Forrest grade/n （%）			0.731	0.866
Ⅰb	5 （6.8）	6 （8.2）
Ⅱa	15 （20.5）	14 （19.2）
Ⅱb	26 （35.6）	30 （41.1）
Ⅱc	27 （37.0）	23 （31.5）

Item	Joint group （n=73）	Control group （n=73）	t/χ² value	P value
Gender/n （%）			0.111	0.739
Male	42 （57.5）	40 （54.8）
Female	31 （42.5）	33 （45.2）
Age/year	38.56±7.83	39.12±7.62	0.438	0.662
Cause of hemorrhage/n （%）			1.335	0.721
Erosive gastritis	19 （26.0）	17 （23.3）
Gastric ulcer	15 （20.6）	21 （28.8）
Digestive tract tumor	16 （21.9）	14 （19.2）
Duodenal ulcer	23 （31.5）	21 （28.8）
Antithrombotic drug therapy/n （%）			1.043	0.307
Yes	31 （42.5）	25 （34.2）
No	42 （57.5）	48 （65.8）
Modified Forrest grade/n （%）			0.731	0.866
Ⅰb	5 （6.8）	6 （8.2）
Ⅱa	15 （20.5）	14 （19.2）
Ⅱb	26 （35.6）	30 （41.1）
Ⅱc	27 （37.0）	23 （31.5）

Item	Joint group（n=73）	Control group（n=73）	χ² value	P value
Efficacy/n （%）			2.110	0.035
Marked improvement	48 （65.8）	37 （50.7）
Moderate improvement	22 （30.1）	26 （35.6）
No improvement	3 （4.1）	10 （13.7）
Total effective rate/%	95.89	86.30	4.138	0.042

Item	Joint group（n=73）	Control group（n=73）	χ² value	P value
Efficacy/n （%）			2.110	0.035
Marked improvement	48 （65.8）	37 （50.7）
Moderate improvement	22 （30.1）	26 （35.6）
No improvement	3 （4.1）	10 （13.7）
Total effective rate/%	95.89	86.30	4.138	0.042

Item	Joint group （n=73）		Control group （n=73）
Item	Pre-treatment	Post-treatment for 5 d	Pre-treatment	Post-treatment for 5 d
PGE₂/（pg·mL^-1）	211.54±30.43	308.62±25.46^①②	211.95±31.73	279.89±27.54^①
6-Keto-PGF_1α/（pg·mL^-1）	185.42±22.86	117.95±19.51^①②	184.04±21.31	140.45±20.63^①