The Efficacy Of Pantoprazole Combined With Somatostatin In The Treatment Of Esophagogastric Variceal Bleeding And Its Influence On Hemodynamics In Cirrhosis

Objective Upper gastrointestinal bleeding is the most common serious complication of liver cirrhosis.Esophagogastric variceal bleeding is the most common and dangerous cause of upper gastrointestinal bleeding in decompensated liver cirrhosis It is also the main cause of death in patients with upper gastrointestinal bleeding due to liver cirrhosis.The therapeutic purpose of acute variceal bleeding is to get rapid and effectively hemostasis and reduce the incidence of rebleeding.Since the mechanism of vasoactive drugs such as somatostatin and pituitrin and proton pump inhibitor are different in the treatment of upper gastrointestinal hemorrhage,our aim is to evaluate the efficacy of Pantoprazole combined with Somatostatin in the treatment of esophagogastric variceal bleeding and its influence on hemodynamics in cirrhosis.Hemodynamic indexes of portal vein and splenic vein were measured by color Doppler ultrasound diagnostic apparatus.Methods According to the inclusion and exclusion criteria,between January 2014 to October 2015,92 cases of cirrhotic patients presenting with acute esophagogastric variceal bleeding in N0.454 Hospital of PLA were considered for enrollment in the study.They have been divided into two groups according to random number table,46 cases in each group.Cases in combined group received Pantoprazole combined with Somatostatin,and cases in control group received vasopressin.General treatments such as enlarging blood volume,maintaining water electrolyte and acid-base balance,and prophylactic use of antibiotics of the two groups such are the same.The symptoms,signs and laboratory examinations after treatment of the two groups were observed.The hemostasis time,volume of blood transfusion and days of hospitalization were recorded.Monitoring arterial blood pressure of the upper extremities and calculating mean arterial blood pressure.Through the supraclavicular vein puncture,the central venous pressure was measured through the right heart catheter.Then the treatment efficacy,hemodynamic changes and adverse drug reactions of the two groups were compared.Results The success rate of hemostasis and the effective rate of variceal therapy were higher than that of control group(P<0.05).The early rebleeding rate of combined group was lower than that of control group(P<0.05).The transfusion volume,hemostatic time and length of hospital stay were less than those of control group(P<0.05).The internal diameter of portal vein,splenic vein and left gastric vein post-treatment of combined group and control group were smaller than those before treatment(P<0.05).The blood flows of portal vein and splenic vein were reduced than those before treatment(P<0.05).The mean arterial pressure and central venous pressure post-treatment were higher than those before treatment(P<0.05).Heart rate post-treatment was lower than that before treatment(P<0.05).The degrees of variability in indexes above of combined group were higher than those of control group(P<0.05).Conclusion Pantoprazole combined with Somatostatin in the treatment of esophagogastric variceal bleeding in cirrhosis is effective in hemostasis.Meanwhile the treatment of combination can also improve hemodynamic state,which may improve hemostatic effect.Since the treatment scheme is easy to obtain,it can be carried out quickly when patients suspected or diagnosed with esophagogastric variceal bleeding,and it is easy to master by hospitals and clinicians at all levels.It is worth popularizing and applying.