摘要目的:探讨奥曲肽联合凝血酶治疗血吸虫性肝硬化上消化道出血的疗效。方法:采用前瞻性设计，在2017年1月至2019年1月，以滨州市人民医院收治的血吸虫性肝硬化上消化道出血患者86例作为研究对象，年龄为34~62岁，按照随机数字表法分为对照组（ n = 43）和观察组（ n = 43）。两组患者均静滴20 U垂体后叶素（滴速为0.4 U/min），治疗24 h后改为半量维持，控制出血后24 h停止静滴；0.1 mg奥曲肽静脉推注，以25 μg/h的速度持续静脉泵入，控制出血后继续泵入2~3 d。在此基础上，观察组患者10 U/ml凝血酶胃管灌注，间隔4 h实施1次，持续3 d。比较两组临床疗效、止血情况及不良反应发生情况，同时比较治疗3 d后两组门静脉、脾静脉血流量，肝功能指标[总胆红素（TBil）、谷丙转氨酶（ALT）、谷草转氨酶（AST）]。 结果:观察组总有效率（93.02%，40/43）显著高于对照组（76.74%，33/43， P < 0.05），止血时间、输血量及再出血率[（19.25 ± 3.28）h、（214.58 ± 42.45）ml、6.98%（3/43）]显著低于对照组[（27.47 ± 3.93）h、（394.66 ± 67.52）ml、27.91%（12/43）， P均< 0.05]。治疗3 d后，观察组门静脉、脾静脉血流量[（276.68 ± 54.36）、（552.49 ± 67.83）ml/min]显著低于对照组[（307.52 ± 59.67）、（598.53 ± 73.28）ml/min， P均< 0.05]；血清TBil、AST及ALT水平[（42.96 ± 8.44）μmol/L，（36.47 ± 6.53）、（31.74 ± 6.39）U/L]显著低于对照组[（73.36 ± 9.67）μmol/L，（54.25 ± 8.74）、（50.28 ± 9.26）U/L， P均< 0.05]。观察组不良反应总发生率（16.28%，7/43）显著低于对照组（37.21%，16/43， P < 0.05）。 结论:奥曲肽联合凝血酶治疗血吸虫性肝硬化上消化道出血效果显著，可有效控制出血，改善患者门静脉、脾静脉血流情况和肝功能，且具有较高的安全性，值得临床推广使用。

abstractsObjective:To investigate the efficacy of octreotide combined with thrombin in the treatment of upper gastrointestinal bleeding in schistosomiasis cirrhotic patients.Methods:Using prospective design, from January 2017 to January 2019, 86 patients with upper gastrointestinal bleeding caused by schistosomiasis cirrhosis in Binzhou People's Hospital were selected as subjects, aged 34 - 62 years. According to the random number table method, they were divided into control group ( n = 43) and observation group ( n = 43). In two groups, the patients were given 20 U of pituitrin (with a drip rate of 0.4 U/min), after 24 h of treatment, it was changed to a half-dose maintenance, and was stopped after 24 h of bleeding control; 0.1 mg octreotide was used for intravenous injection, continuous intravenous pumping at a rate of 25 μg/h, and continued to pump 2 to 3 days after controlling bleeding. On this basis, the patients in the observation group were perfused with 10 U/ml thrombin. It was implemented once at an interval of 4 hours for 3 days. The clinical efficacy, hemostasis and adverse reactions were compared between the two groups. At the same time, the blood flow of portal vein and splenic vein and liver function indexes [total bilirubin (TBil), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST)] were compared between the two groups after 3 days of treatment. Results:The total effective rate in the observation group (93.02%, 40/43) was significantly higher than that in the control group (76.74%, 33/43, P < 0.05). The hemostatic time, blood transfusion volume and rebleeding rate in the observation group [(19.25 ± 3.28) h, (214.58 ± 42.45) ml, 6.98% (3/43)] were significantly lower than those in the control group [(27.47 ± 3.93) h, (394.66 ± 67.52) ml, 27.91% (12/43), P <0.05]. After 3 days of treatment, the blood flow of portal vein and splenic vein in the observation group [(276.68 ± 54.36), (552.49 ± 67.83) ml/min] were significantly lower than those in the control group [(307.52 ± 59.67), (598.53 ± 73.28) ml/min, P < 0.05]. After 3 days of treatment, the levels of serum TBil, AST and ALT in the observation group [(42.96 ± 8.44) μmol/L, (36.47 ± 6.53) U/L, (31.74 ± 6.39) U/L] were significantly lower than those in the control group [(73.36 ± 9.67) μmol/L, (54.25 ± 8.74) U/L, (50.28 ± 9.26) U/L, P < 0.05]. The total incidence of adverse reactions in the observation group (16.28%, 7/43) was significantly lower than that in the control group (37.21%, 16/43, P < 0.05). Conclusions:Octreotide combined with thrombin is effective in the treatment of upper gastrointestinal bleeding caused by schistosomiasis cirrhosis. It can effectively control bleeding, improve portal vein and splenic vein blood flow and liver function, and has high safety, so it is worthy of clinical promotion.