The Study Of The Effects Of Terlipressin And Octreotide On Hemodynamics In Cirrhotic Patients With Variceal Veins

Objective:Vasoactive drugs such as terlipressin and octreotide can effectively control acute variceal bleeding with little adverse reaction and high safety, the purpose of this study is to observe and compare the effectiveness and safety of terlipressin and octreotide of double doses in decreasing HVPG value of cirrhotic patients with variceal veins.Materials and Methods:41 cirrhotic patients with variceal veins were randomly divided into two groups and hidden by envelope method. Patients who met the standards of inclusion and exclusion criteria were measured and recorded the baseline values of WHVP, FHVP, HVPG, HR and MAP for the first time before administration.Group A (terlipressin group) were first intravenously injected with 10ml normal saline and 2mg terlipressin for 10 minutes, followed by continuous infusion of normal saline at the speed of 50ml/h; group B (octreotide of double doses group) were first intravenously injected with 10ml normal saline and 100μg octreotide, followed by continuous infusion of 100ml normal saline and 100μg octreotide at the speed of 50ml/h. Changes of the above indexes were observed after 10min,20min and 30min of drugs administration. The HVPG response was defined as HVPG value decrease 10% compared with baseline value or decreased below 20mmHg.The major indexes of this study were absolute values, extents of HVPG lower than baseline values and response rate, secondary indexes were changes of MAP and HR values and the incidence rate of adverse drug reactions, SPSS 17.0 statistical software was applied to the statistical analysis of all data and P<0.05 was considered of statistical significance.Results:There were significant differences in HVPG, FHVP, WHVP, HR and MAP values changes after administration of 10min,20min and 30min compared with the baseline values in group A (terlipressin group) patients (P<0.05); 20min FHVP values were higher than 10min values (P<0.05),30min WHVP values were lower than 20min values (P<0.05). Of patients in group B (octreotide of double doses group), compared with the baseline values, HVPG values of 10min,20min and 30min after administration significantly decreased (P<0.05), FHVP values of 10min and 20min increased (P<0.05), WHVP values of 20min and 30min decreased (P<0.05), HR values decreased and MAP values increased of 10min (both P values were less than 0.05); 20min WHVP and FHVP values were both lower than that of 10min (both P values were less than 0.05),30min FHVP values were lower than that of 20min (P<0.05).For comparisons between group A and group B, HVPG response rate, absolute values and extent decreased from baseline levels showed no significant difference (P values were all greater than 0.05), but the extent of HR values decrease and MAP values increase in terlipressin group were greater than octreotide of double doses group (P<0.05). The occurrence rate of adverse reactions in two groups showed no significant difference (P>0.05).Analysis on the influence factors of baseline HVPG values showed that it associated with ALB (P<0.001,r=-0.547), PALB (P<0.001, r=-0.414), PT (P=0.002, r=0.474), INR (P=0.002, r=0.472) and Child-Pugh score (P<0.001, r=0.530). Analysis on the influence factors of the HVPG response indicated it was related to bleeding times (P=0.015, r=-0.376).Conclusion:1.Compared with baseline HVPG values, HVPG values of 10min,20min,30min after administration in both groups were decreased. HVPG response rate, absolute value and extent decreased from baseline levels and occurrence rate of adverse reactions in two groups showed no significant difference.2.Compared with octreotide administration, terlipressin increased FHVP values slower but longer and decreased WHVP values at a earlier time.3.Extents and duration of HR values decrease and MAP increase after terlipressin administration was greater than octreotide, which may indicate more attention should be paid to patients treated with terlipressin, especially in HR and MAP.4.The higer the values of PT, INR and Child-Pugh score, the lower the level of ALB and PALB, the higher the HVPG baseline values might be. Patients with more bleeding times were more likely to be of no HVPG response to octreotide and terlipressin administration.