Octreotide treatment of 35 cases of upper gastrointestinal bleeding


Bleeding l7 cases. The control group l6 cases, male l4 cases, 2 females, average age 49 years. First bleeding in 9 cases, re-bleeding in 7 cases. A bleeding esophageal varices l0 cases of peptic ulcer bleeding in 6 cases. 1.2 treatment group: Hospice lOOpg 20ml normal saline intravenous infusion followed by 25h to maintain, such as failure to stop bleeding after 24h, then increase the dose to 50t ~ dh maintain, all drugs are more than 72h. Control group: vasopressin 20U added to 200ml of 10% glucose solution intravenously per minute 0.4U speed, continuous 12h, if effective and further to 0.2U per minute intravenous infusion, maintained up to 48h and then reduced to 0 per minute .1 U, maintained up to 72h. Nitroglycerin were added through the tee and vasopressin in the same intravenous drip channel people, dropping 10 ~ 40 ~ / mm, to maintain systolic blood pressure at 12kPa above,Écharpe Burberry, the amount can be flexibly adjusted. The medication at the same time, both groups application of thrombin (or norepinephrine) or gastric tube into the oral, intravenous reptilase l ~ 2U and intravenous omeprazole 40rag,doudoune moncler homme, 1 or 2 times, d, and other auxiliary support treatment . 1.3 Observation items were placed in all patients before treatment tube, suction and washed every 4h 1, the gastric juice to clear the bleeding index. While observing vital signs. 1.4 Clinical criteria markedly: bleeding within 24h after treatment,Nike Schuhe Günstig, with stable vital signs. Effective: 48h bleeding to stop by. Invalid: 48h after the patient is still vomiting, melena, bloody juice out of the stomach, unstable vital signs. 2 Results 2.1 treatment group after 26 cases markedly effective in 7 cases, 2 cases, there is always Author: 1. Forest City, Henan Province,ugg boots norge, the fifth hospital (45655O) 2. Forest City People's Hospital Author: Yu-Ming Liu, 35 years old, attending physician. Research: cardiovascular and cerebrovascular disease prevention and control efficiency of 94.2% overall. 2.2 in control group after treatment effective in 3 cases, effective in 8 cases, 5 cases, the total efficiency of 68%. The two groups can not stop bleeding after medical treatment of 72h were transferred other treatments. Where l deaths,uggs Günstig, l gave up treatment. 2.3 Conclusion treatment group was 94.2% higher than the control group 68%, P <0.05, significant difference. That octreotide treatment of upper gastrointestinal bleeding than vasopressin plus nitroglycerin treatment. Of particular note is the treatment group and control group, the gap between the number of cases markedly greater. 3 to discuss the case fatality rate of upper gastrointestinal bleeding with hemorrhage and thus different, about 4.7% to 50%. Vasopressin was extracted from the posterior pituitary nine peptides, intravenous many systemic effects, including contraction of small arteries, veins and small veins visceral contraction, contraction of esophageal smooth muscle and increase gastric motility. Based on its reduced splanchnic portal blood flow, reduce portal pressure and lateral pressure, commonly used in the esophagus in patients with a variceal bleeding, also used in the treatment of peptic ulcer bleeding. In the application of vasopressin at the same time giving nitroglycerin can reverse almost all the side effects of the former, nitroglycerin, and also through the expansion of intrahepatic collateral vessels, reducing portal resistance, but also by stimulating baroreceptor reflex contraction of visceral blood vessels, reduce portal collateral blood flow to reduce portal pressure, twist anti-vasopressin side effects also play a synergistic therapeutic effect. Octreotide is a synthetic octapeptide somatostatin derivatives, and similar to the role of natural somatostatin, but its long half-life, can effectively inhibit gastric acid secretion, pepsin inhibition of the release, the splanchnic vascular contraction be more selective, can be contracted splanchnic blood vessels and reduce portal pressure and reduce the portal blood flow. Reports have confirmed intravenous octapeptide endostatin lO0/zg, lOmin after the visceral venous pressure drop 5l%. Also by direct inhibition of glucagon and other vasoactive substances released to reduce the level of visceral blood vessels to dilate blood vessels of internal organs or indirectly enhance the vasoconstrictor response. Good rather than vasopressin plus nitroglycerin treatment is not only good, and easy to use, side effects, is now increasingly being used in the treatment of various types of gastrointestinal bleeding. [
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