目的 对照观察肝硬化急性食管胃静脉曲张出血（EVB）常用治疗药物生长抑素、特利加压素及其联合治疗与加用或不加用抗生素等不同策略的疗效。方法 选取联勤保障部队第九〇〇医院收治的肝硬化食管胃静脉曲张首次破裂急性出血的患者97例，根据用药不同分为对照组（39例，生长抑素治疗）和治疗组（58例，生长抑素联合特利加压素治疗）。对照组应用十四肽生长抑素250~500 μg/h持续静脉泵入；治疗组在对照组基础上加用特利加压素4~6 mg/d，持续静脉泵入，活动性出血控制后，特利加压素改为2 mg/d持续静脉泵入。观察两组患者止血成功率、止血时间、再出血率及死亡率的差异。并将两组患者中是否加用抗生素进行亚组分析，对比两种治疗策略中加用抗生素对急性食管胃静脉曲张出血的止血效果及患者生存率的影响。结果 （1）两种治疗策略疗效比较：治疗组与对照组比较，止血成功率（75.86%vs 56.41%，χ²=4.058，P=0.044），止血所需时间[（4.3±2.0）d vs（5.5±2.6）d，t=2.297，P=0.024]和再出血率（5.17%vs 20.51%，2χ=5.458，P=0.025）差异均具有统计学意义。但两组患者死亡率（18.97%vs 12.82%，χ²=0.639，P=0.424）比较差异无统计学意义。（2）抗生素对EVB治疗效果的影响：在对照组中加抗生素与未加抗生素组相比，止血成功率（63.16%vs 50.00%，χ²=0.686，P=0.408）、止血时间[（5.2±2.9）d vs（5.9±2.0）d，t=-0.740，P=0.465]和再出血率（15.79%vs 25.00%，χ²=0.507，P=0.695）差异均无统计学意义，但两组患者死亡率（0.00%vs 25.00%，χ²=5.449，P=0.047）差异具有统计学意义；在治疗组中加抗生素与未加抗生素组相比止血成功率（78.72%vs 63.64%，χ²=1.108，P=0.433），再出血率（6.38%vs 0.00%，χ²=0.740，P=1.000）和死亡率（14.89%vs 36.36%，χ²=2.674，P=0.102）差异均无统计学意义，但两组患者的止血时间[（4.1±1.8）d vs（5.7±2.4）d，t=-2.045，P=0.047]差异具有统计学意义。结论 生长抑素联合特利加压素治疗肝硬化急性食管胃静脉曲张出血患者的止血成功率、止血时间、再出血发生率均优于生长抑素单药治疗组，因此认为生长抑素联合特利加压素是目前急性食管胃静脉曲张出血相对较好的治疗策略；抗生素在生长抑素单药治疗组和生长抑素与特利加压素联合治疗组中得出的结果不一致，抗生素在肝硬化EVB治疗中的作用和价值尚不确定。

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 A total of ninety-seven cases of acute hemorrhage of esophageal gastric varices with cirrhosis were collected in 900 Hospital of the Joint Logistics Team. They were divided into two groups, as somatostatin treatment group (n=39), somatostatin combined with terlipressin (n=58). Somatostatin treatment group received somatostatin 250-500 μg/h by continuous intravenous infusion. The combined treatment group received fourteen peptide somatostatin and terlipressin at a dose of 4-6 mg/d simultaneously by continuous intravenous infusion. When the bleeding was ceased, terlipressin dosing was adjusted to 2 mg/d. The hemostasis rate, hemostasis time, re-bleeding rate and mortality rate were analyzed.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±2.0) d vs 5.5±2.6) d, 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±2.9) d vs 5.9±2.0) d, 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±1.8)d vs (5.7±2.4) d, t=-2.045, P=0.047] the difference was statistically significant. Conclusion 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, somatostatin combined with terlipressin group is currently better treatment strategies for acute esophageal and gastric variceal hemorrhage. The effeccts of antibiotics in somatostatin group and somatostatin combined with terlipressin group obtained inconsistent results, so the effeccts of antibiotics in the treatment of cirrhosis of the liver and EVB in this study is yet to be ascertained.

R975;R978.7

福建省社会发展引导性重点项目（2016Y0068）