| OBJECTIVE: to investigate the therapeutic effects of somatostatin alone or somatostatin combined with terlipressin, each with or without the use of antibiotics, on esophageal and gastric variceal bleeding in patients with cirrhosis; To further optimize the non-invasive treatment strategy for EVB caused by liver cirrhosis.METHODS:(1)Ninety-seven cases of acute hemorrhage of esophageal gastric varices in patients with cirrhosis. They were divided into two groups, as somatostatin treatment group(n=39), somatostatin combined with terlipressin(n=58).Somatostatin treatment group received somatostatin 250- 500μg/h by continuous intravenous infusion. The combined treatment group received fourteen peptide somatostatin and terlipressin at a dose of 4mg- 6mg/d simultaneously by continuous intravenous infusion. When the bleeding was ceased, terlipressin dosing was adjusted to 2mg / d. The treatment time were 3- 5 days for both groups. Other therapies including fluid resuscitation, transfusion and inhibition of gastric acid secretion with proton pump inhibitors were identical in the two groups. The hemostasis rate, hemostasis time, re-bleeding rate and mortality rate were analyzed. Failure of drug treatment was defined as deterioration of bleeding during treatment or ongoing bleeding after treatment for > 5 days. In such cases, endoscopic therapy, transjugular intrahepatic portosystemic shunt or surgical treatment were performed promptly.(2)Sstratified analysis based on the use of antibiotics for hemostasis rate of esophageal gastric bleeding and survival rate were conducted.RESULTS:(1) Comparison of the efficacy of two treatment strategies: combined treatment group and somatostatin monotherapy group compared the success rate of hemostasis(75.86% vs 56.41%, χ2=4.058, P= 0.044), hemostasis time(4.3±2.0d vs 5.5± 2.6d, t=2.297, P=0.024) and rebleeding rate(5.17% vs 20.51%, χ2=5.458,P=0.025).Differences were with statistical significance. There was no statistical difference between the two groups of patient mortality(18.97% vs 12.82%, χ2=0.639, P=0.424).(2)The effect of antibiotics on the treatment of EVB:with antibiotics in somatostatin treatment group compared with non antibiotic group success rate of hemostasis(63.16% vs 50%,χ2=0.686,P=0.408), bleeding time(5.2±2.9d vs 5.9±2.0d t=-0.740, P=0.465) and rebleeding rate(15.79% vs 25%, χ2=0.507,P=0.695) were not statistically significant. But the difference of the mortality rate of patients in the two groups(0% vs 25% χ2=5.449,P=0.047), were statistically significant; With antibiotics in the combination therapy group compared with non antibiotic group hemostasis success rate(78.72% vs 63.64%, χ2=1.108,P=0.433), rebleeding rate(6.38% vs 0%, χ2= 0.740,P=1.000) and mortality(14.89% vs 36.36%, χ2=2.674, P=0.102) had no statistical significance. But the two groups of patients with bleeding time(4.1±1.8d vs 5.7±2.4d,t=-2.045,P=0.047) the difference was statistically significant.CONCLUSION:1.The success rate of hemostasis, hemostasis time, rebleeding occurrence rate of somatostatin combined terlipressin in treating liver cirrhotic patients with acute esophageal and gastric variceal bleeding were better than the single drug treatment with somatostatin. Therefore, somatostatin combined with terlipressin group is currently better treatment strategies for acute esophageal and gastric variceal hemorrhage.2.The effeccts of antibiotics in somatostatin group and somatostatin combined with terlipressin group obtained inconsistent results. Therefore, the effeccts of antibiotics in the treatment of cirrhosis of the liver and EVB in this study is yet to be ascertained. |
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