背景： 肝硬化是很多肝病患者最後經歷之階段，而這些患者常因其相關併發症而死亡，食道靜 脈瘤出血便是其中一種。當患者發生食道靜脈瘤出血時，利用血管收縮作用劑合併內視 鏡處理是目前最常使用的治療方式。本研究目的在探討不同血管收縮作用劑在這種治療 模式中其療效及金錢花費是否有何差異。
方法： 搜尋院內 92 年 1 月至 96 年 10 月間第一次單獨使用 terlipressin 或 somatostatin 合併內視 鏡治療之肝硬化引起食道靜脈瘤出血患者並進行病歷分析。主要觀察指標為患者之五天 死亡率及止血率、42 天死亡率及再入院率、平均住院天數、平均輸血量及住院期間的直 接花費。另探討性別、年齡、肝硬化程度、血色素和血容比狀況與藥物治療之關連性。 結果： 共 納入 terlipressin 組 38 人 ， somatostatin 組 50 人進 行結果 分析。 terlipressin 組 與 somatostatin 組其結果分別為：五天之死亡率皆為零；五天的止血率 100%及 98%；42 天死亡率 0%及 2.1%；42 天再入院率 13.2%及 8.7%；平均住院天數 8.45 及 7.58 天；平均 輸血量 7.32 U 及 7.40 U，兩組之間無顯著差異。血管收縮作用劑花費上，terlipressin 組 明顯低於 somatostatin 組(15,886 元比上 20,272 元，P = 0.020)，其他的花費則無顯著差異。 男性、年齡＞60 歲、Child-Turcotte-Pugh class B 和 C、hemoglobin (Hb)＞10 g/dL 及 hematocrit (Ht)≧30 %患者接受 somatostatin 及 terlipressin 治療，入住加護病房天數分別 為 0.95/2.48, 1.20/2.64、1.50/3.33、1.26/3.37 及 1.39/2.90 天，皆達明顯差異(P<0.05)。
結論： 非酒精性肝硬化且未罹患任何癌症患者第一次單獨使用 terlipressin 或 somatostatin 合併 內視鏡處理食道靜脈瘤出血之療效相當。在住院期間之直接花費，兩組藥物之間沒有顯著差異，但在血管收縮作用劑之藥品費用支出方面，terlipressin 顯著低於 somatostatin。在患者背景變數探討方面，男性、年齡＞60 歲、Child-Turcotte-Pugh class B 和 C、Hb＞10 g/dL 及 Ht≧30 %患者使用 somatostatin 治療可以縮短患者入住加護病房時間。
Background: The patients with liver cirrhosis commonly died due to its complications, including esophageal variceal bleeding. The currently recommended treatment for esophageal variceal bleeding is the association of vasoactive agents and endoscopic therapy. The aim of the study was to investigate the efficacy and the cost of different vasoactive agents in this therapeutic model.
Methods: The cirrhotic patients with esophageal variceal bleeding and treated for the first time with terlipressin or somatostatin in combination with endoscopic therapy were studied retrospectively. The outcome measures were 5-day mortality, 5-day hemostasis, 42-day mortality, 42-day re-hospitalization, the mean length of stay (LOS), the mean blood transfusion, and direct cost during the hospitalization. We also investigated the relationship between the drug therapy and the variables of patients such as sex, age, level of liver cirrhosis, hemoglobin (Hb), and hematocrit (Ht).
Results: 88 patients were enrolled: 50 received somatostatin and 38 received terlipressin. There were no significant difference between terlipressin group and somatostatin group in all outcome measures except the cost of vasoactive agents (NT$ 15,886 vs. NT$ 20,272, P = 0.020). For the patients of male, age older than 60 years, Child-Turcotte-Pugh class B and C, Hb >10 g/dL, and Ht≧30%, the
mean LOS of intensive care unit (ICU) of somatostatin and terlipressin treatment were 0.95/2.48,1.20/2.64, 1.50/3.33, 1.26/3.37, 1.39/2.90 days, respectively and all statistically significant difference (P< 0.05).
Conclusions: The efficacy of the combination treatment of somatostatin and endoscopic therapy is similar to that of terlipressin for the cirrhotic patients with esophageal variceal bleeding except alcoholic cirrhosis and any cancers. For direct cost during the hospitalization, there is no significant difference between two vasoactive agents. But terlipressin is cheaper than somatostatin in the cost of vasoactive agents. For the variables of patients such as male, age older than 60 years, Child-Turcotte-Pugh class B and C, Hb >10 g/dL, and Ht ≧30%, the mean LOS of ICU can be reduced by the combination treatment of somatostatin.
