gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1232Research ArticleГЕПАТОЛОГИЯHEPATOLOGYПрименение терлипрессина при кровотечениях из варикознорасширенных вен пищевода у больных циррозом печени с синдромом портальной гипертензииTerlipressin at esophageal varicose bleeding at liver cirrhosis with portal hypertension syndromeКотивБ. Н.KotivB. N.ДзидзаваИ. И.DzidzavaI. I.КашкинД. П.KashkinD. P.СмородскийА. В.SmorodskyA. V.СлободяникА. В.SlobodyanikA. V.СолдатовС. А.SoldatovS. A.КолдинМ. В.KoldinM. V.Федеральное государственное бюджетное военное образовательное учреждение высшего профессионального образования «Военно-медицинская академия им. С.М. Кирова» МО РФРоссияState military educational government-financed institution of higher professional education «Kirov military medical academy» Ministry of Defense of the Russian FederationRussian FederationФедеральное государственное бюджетное военное образовательное учреждение высшего профессионального образования «Военно-медицинская академия им. С.М. Кирова» МО РФРоссия2013241020132355764Copyright © Котив Б.Н., Дзидзава И.И., Кашкин Д.П., Смородский А.В., Слободяник А.В., Солдатов С.А., Колдин М.В., 20132013Котив Б.Н., Дзидзава И.И., Кашкин Д.П., Смородский А.В., Слободяник А.В., Солдатов С.А., Колдин М.В.Kotiv B.N., Dzidzava I.I., Kashkin D.P., Smorodsky A.V., Slobodyanik A.V., Soldatov S.A., Koldin M.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1232

Цель исследования. Сравнить эффективность вазоактивной терапии терлипрессином и октреотидом при кровотечениях из варикозно-расширенных вен пищевода у больных циррозом печени.Материал и методы. Исследование основано на ретроспективном анализе результатов лечения 72 больных циррозом печени с синдромом портальной гипертензии. В соответствии с критериями Child–Pugh пациенты распределились следующим образом: класс А – 12 (16,7%), класс В – 41 (56,9%), класс С – 19 (26,4%). В качестве вазоактивных препаратов использовали терлипрессин (основная группа, n=32) и октреотид (контрольная группа, n=40). Обе группы были сопоставимы по возрасту, полу, этиологии цирроза, степени варикозного расширения вен пищевода и тяжести гепатодисфункции.Результаты. Назначение терлипрессина снижало темп кровотечения и способствовало достижению временного гемостаза у 71,9% больных, а применение октреотида только в 55% случаев. Ранний рецидив пищеводного кровотечения развился в основной группе в 6,3% наблюдений, в контрольной – в 12,5% (р<0,05). Введение терлипрессина сопровождалось достоверным снижением как линейной, так и объемной скорости кровотока по воротной вене в среднем на 41,6±9,7% (р=0,038) и 33,9±5,8% (р=0,024), соответственно. Данный эффект наблюдался более 60 мин от момента инъекции. После введения октреотида также отмечено снижение основных скоростных характеристик портального кровотока: линейная скорость снизилась на 34,1±10,3% (р=0,030), а объемная – на 28,6±9,8% (р=0,041). Однако через 60 мин после введения октреотида оба показателя восстанавливались практически до исходного уровня (р>0,05). В обеих группах введение исследуемых препаратов сопровождалось изменением параметров центральной гемодинамики. Хотя снижались и величина среднего артериального давления, и частота сердечных сокращений, только уменьшение сердечного выброса в основной группе достоверно отличалось от исходных значений.Заключение. Терлипрессин оказывает более значимое влияние на портальную гемодинамику и обладает относительно большей эффективностью в сравнении с октреотидом при возникновении кровотечений портального генеза.

Aim of investigation

Aim of investigation. To compare efficacy of vasoactive therapy by terlipressin and octreotide at bleeding from varicose veins of the esophagus in patients with liver cirrhosis.

Material and methods

Material and methods. Investigation was based on the retrospective analysis of results of treatment of 72 patients with liver cirrhosis and portal hypertension syndrome. According to Child-Pugh criteria patients were distributed as follows: class A – 12 (16,7%), class B – 41 (56,9%), class C – 19 (26,4%). Terlipressin (main group, n=32) and octreotide (control group, n=40) were used as vasoactive drugs. Both groups have been comparable by age, gender, etiology of cirrhosis, degree of varicose dilation of esophageal veins and severity of liver dysfunction.

Results

Results. Terlipressin prescription reduced rate of bleeding and promoted achievement of temporary hemostasis in 71,9% of patients, while application of octreotide – only in 55% of cases. Early relapse of esophageal bleeding has developed in the main group in 6,3% of cases, in control – in 12,5% (р<0,05). Terlipressin injection was accompanied by significant decrease both linear, and volume velocity of portal blood flow on average by 41,6±9,7% (р=0,038) and 33,9±5,8% (р=0,024), respectively. This effect was observed for over 60 mines from the moment of injection. After injection of octreotide decrease of main velocity features of portal blood flow was marked as well: linear speed has decreased by 34,1±10,3% (р=0,030), and volume – by 28,6±9,8% (р=0,041). However in 60 min after injection of octreotide both parameters returned almost to baseline level (р>0,05). In both groups injection of studied agents was accompanied by change of parameters of central hemodynamics. Though the level of mean blood pressure and heart rate decreased, only reduction of cardiac output in the main group significantly differed from reference values.

Conclusion

Conclusion. Terlipressin has more significant effect on portal hemodynamics and possesses the greater efficacy in comparison to octreotide at bleeding of portal origin.

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The authors declare that there are no conflicts of interest present.