EARLY ADMINISTRATION OF TERLIPRESSIN PLUS GLYCERYL TRINITRATE TO CONTROL ACTIVE UPPER GASTROINTESTINAL-BLEEDING IN CIRRHOTIC-PATIENTS
EARLY ADMINISTRATION OF TERLIPRESSIN PLUS GLYCERYL TRINITRATE TO CONTROL ACTIVE UPPER GASTROINTESTINAL-BLEEDING IN CIRRHOTIC-PATIENTS
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DOI：
10.1016/s0140-6736(95)92708-5
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发表时间：
1995-09-30
期刊：
影响因子：
168.9
通讯作者：
POURRIAT, JL
中科院分区：
文献类型：
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作者：
LEVACHER, S;LETOUMELIN, P;POURRIAT, JL
上消化道出血是消化道疾病的主要并发症。内窥镜检查和食管硬化是参考治疗，必须尽快进行。然而，这样的治疗是不可能的，除非患者入院hospital.In前瞻性，随机，双盲试验，我们比较了特利加压素联合硝酸甘油酯（TER-GTN），尽早给予76例肝硬化患者有活动性GIB（84出血事件）的疗效。如果患者有胃肠道出血、肝硬化病史和临床体征，则由急诊团队（移动的重症监护室）的医生在患者家中进行输液。患者接受TER-GTN静脉注射（1至2 mg）或双重安慰剂注射，然后在4和8 h再次注射。评价第15天和第42天的出血控制、再出血和死亡率。在大多数患者中，内窥镜检查证实食管静脉曲张破裂（75.7%），TER-GTN组（n=41）的出血控制显著优于双安慰剂组（n=43）（p=0.034）。在第15天（p=0.035）和第42天（p=0.06），TER-GTN组因出血事件导致的死亡率显著低于双安慰剂组。没有严重的副作用。早期给予TER-GTN降低了长期低血容量对这些患者肝功能的有害后果。
Upper gastrointestinal bleeding (GIB) is major complication in cirrhotic patients. Endoscopy and oesophageal sclerosis are reference treatments and must be done as soon as possible. However, such treatment is not possible unless the patient is admitted to hospital.In a prospective, randomised, double-blind trial, we compared the efficacy of terlipressin combined with glyceryl trinitrate (TER-GTN), administered as early as possible to 76 patients with cirrhosis who had active GIB (84 bleeding episodes). Infusion was done at the patient's home by the physician on the emergency team (a mobile intensive care unit) if the patient had GIB and a history and clinical signs of cirrhosis. Patients received either an intravenous injection (1 to 2 mg) of TER-GTN or a double placebo injection, and then another injection at 4 and 8 h. Control of bleeding, rebleeding, and mortality rate at days 15 and 42 were evaluated. In most patients, endoscopy confirmed the rupture of oesophageal varices (75.7%), Bleeding control was significantly better in the TER-GTN group (n=41) than in the double-placebo group (n=43) (p=0.034). Mortality due to bleeding episodes was significantly lower in the TER-GTN group than in the double-placebo group at day 15 (p=0.035) and at day 42 (p=0.06). There were no serious side-effects.Early administration of TER-GTN lowers the deleterious consequences of prolonged hypovolaemia on the hepatic function of these patients.