Experience of the use of octreotide for refractory gastrointestinal bleeding in a patient with Jarvik2000 left ventricular assist device
Experience of the use of octreotide for refractory gastrointestinal bleeding in a patient with Jarvik2000 left ventricular assist device
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Jarvik2000左心辅助装置患者使用奥曲肽治疗难治性消化道出血的体会
DOI：
10.1007/s10047-019-01121-7
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发表时间：
2019
影响因子：
1.3
通讯作者：
Fukushima Norihide
中科院分区：
文献类型：
--
作者：
Nakajima-Doi Seiko;Seguchi O;Shintani Y;Fujita T;Fukushima S;Matsumoto Y;Eura Yuka;Kokame Koichi;Miyata S;Matsuda S;Mochizuki H;Iwasaki K;Kimura Y;Toda K;Kumai Y;Kuroda K;Watanabe T;Yanase M;Kobayashi J;Fukushima Norihide
胃肠道出血（GIB）是影响植入式连续血流左心室辅助装置（iLVAD）受者的主要并发症之一，也是再次住院的主要原因。ivad受者的GIB有时是关键的，使用传统方法控制出血是困难的。一名35岁女性在植入Jarvik2000®iLVAD后发生难治性胃息肉和新生血管发育不良。停止抗凝和抗血小板治疗对GIB的影响不大；因此，进行了多次内镜止血治疗。然而，出血复发多次，进行性贫血需要大量红细胞（RBC）输血。此外，von Willebrand因子（VWF）多聚体分析显示高分子量多聚体的丢失，这可能是由于轴流LVAD泵的高速旋转造成的。为了补充VWF，给予低温沉淀，但仅在几天内有效。最后，患者在术后58天接受奥曲肽（一种生长抑素类似物）治疗。开始使用奥曲肽后，柏油样便逐渐减少，治疗前14天贫血进展减慢；因此，在没有额外止血干预（包括低温沉淀管理）的情况下，总红细胞输血量减少。患者术后第68天出现纵隔炎，术后第72天死于败血症。使用奥曲肽无不良反应。虽然观察时间较短，但奥曲肽似乎有助于缓解iLVAD植入后复发性GIB和减少输血。
Gastrointestinal bleeding (GIB) is among the major complications affecting implantable continuous-flow left ventricular assist device (iLVAD) recipients and is the major cause of re-hospitalization. GIB in iLVAD recipients is sometimes critical, and controlling bleeding using conventional approaches is difficult. A 35-year-old woman developed refractory GIB from multiple gastric polyps and de novo angiodysplasia after Jarvik2000®iLVAD implantation. Discontinuation of anticoagulation and antiplatelet therapies had little effect on GIB; thus, multiple endoscopic hemostatic therapies were performed. However, bleeding recurred several times, and red blood cell (RBC) transfusion in large volumes was required for progressive anemia. Furthermore, the von Willebrand factor (VWF) multimer analysis revealed loss of the high-molecular weight multimer, which may have resulted from the high-speed rotation of the axial-flow LVAD pump. To supplement VWF, cryoprecipitate was administered, but it was effective for only several days. Finally, the patient was treated with octreotide, a somatostatin analog, on post-operative day 58. After starting octreotide, tarry stool gradually decreased, and progression of anemia slowed down within the first 14 days of treatment; thus, the total RBC transfusion volume was reduced without additional hemostatic interventions, including cryoprecipitate administration. The patient developed mediastinitis on post-operative day 68 and died of sepsis on post-operative day 72. There was no adverse effect associated with octreotide use. Although the observation period was short, octreotide appears to be useful for resolving recurrent GIB after iLVAD implantation and reducing blood transfusions.