The effect of nutritional support therapy assisting omeprazole and Yunnan Baiyao in the treatment of liver cirrhosis complicated with upper gastrointestinal bleeding and its influence on nutritional status and clinical outcome
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摘要: 目的 探究营养支持疗法辅助奥美拉唑、云南白药在肝硬化合并上消化道出血患者中的应用效果。方法 选取2019年9月-2021年4月收治的104例肝硬化合并上消化道出血患者作为研究对象，按照随机数字表法1∶1比例分为观察组、对照组，各52例。对照组采用奥美拉唑、云南白药治疗，观察组在对照组基础上加用营养支持疗法辅助治疗。比较2组疗效、止血成功者输血量、大便潜血转阴时间、治疗前后营养指标[白蛋白(ALB)、血红蛋白(Hb)、前白蛋白(PA)]、凝血功能[D-二聚体(D-D)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]、免疫功能(CD3+、CD4+、CD4+/CD8+)及临床结局(再出血率、病死率)。结果 观察组总有效率为92.31%，较对照组的76.92%高(P< 0.05)；观察组输血量较对照组少，大便潜血转阴时间较对照组短(P< 0.05)；治疗后观察组ALB、Hb、PA、CD3+、CD4+、CD4+/CD8+水平较对照组高(P< 0.05)；治疗后观察组PT、APTT较对照组长，D-D、FIB较对照组高(P< 0.05)；观察组再出血率较对照组低(P< 0.05)，两组病死率比较，差异无统计学意义(P>0.05)。结论 营养支持疗法辅助奥美拉唑、云南白药治疗肝硬化合并上消化道出血患者效果显著，可加速止血，减少输血量，提高免疫功能，改善凝血功能、营养状态及临床结局。Abstract: Objective To explore the effect of nutritional support therapy assisting omeprazole and Yunnan Baiyao in patients with liver cirrhosis and upper gastrointestinal bleeding.Methods A total of 104 patients with liver cirrhosis and upper gastrointestinal hemorrhage admitted to our hospital from September 2019 to April 2021 were selected as the research objects. According to the random number table method, they were divided into observation groups and control groups at a ratio of 1∶1, with 52 cases in each group. The control group was treated with omeprazole and Yunnan Baiyao, and the observation group was supplemented with nutritional support therapy based on the control group. The efficacy, the amount of blood transfusion for successful hemostasis, the disappearance time of hematemesis, the time for fecal occult blood to turn negative, and the nutritional indicators before and after treatment [albumin(ALB), hemoglobin(HGB), prealbumin(PA)], coagulation function[D-Dimer(DD), prothrombin time(PT), activated partial thromboplastin time(APTT), fibrinogen(FIB)], immune function (CD3+, CD4+, CD4+/CD8+) and clinical outcome (rebleeding Rate, mortality rate) were compared between the two groups.Results The total effective rate of the observation group was 92.31% higher than that of the control group 76.92%(P< 0.05). The amount of blood transfusion in the observation group was less than that in the control group, the hematemesis disappeared, and the time for fecal occult blood to become negative was shorter than that in the control group(P< 0.05). After treatment, the levels of ALB, HGB, PA, CD3+, CD4+, CD4+/CD8+ in the observation group were higher than those in the control group(P< 0.05). After treatment, the PT and APTT of the observation group were longer than those of the control group, and the D-D and FIB were higher than those of the control group(P< 0.05). The rate of rebleeding in the observation group was lower than that in the control group(P< 0.05). There was no statistically significant difference in mortality between the two groups(P>0.05).Conclusion Nutritional support therapy assisted by omeprazole and Yunnan Baiyao is effective in treating patients with liver cirrhosis and upper gastrointestinal bleeding. It can speed up bleeding, reduce blood transfusion, improve immune function, and improve blood coagulation function, nutritional status, and clinical outcomes.
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表 1 2组临床资料比较
例(%)，X±S 资料 观察组(n=52) 对照组(n=52) t/χ2/u P 性别 0.158 0.691 男 29(55.77) 31(59.62) 女 23(44.23) 21(40.38) 年龄/岁 55.15±3.32 54.08±3.17 1.665 0.099 BMI 22.47±1.45 22.21±1.50 0.899 0.371 肝硬化病程/年 2.66±0.38 2.62±0.42 0.509 0.612 Child-Pugh分级 0.196 0.658 B级 39(75.00) 37(71.15) C级 13(25.00) 15(28.85) 肝硬化原因 0.202 0.904 酒精性肝炎 6(11.54) 5(9.62) 病毒性肝炎 37(71.15) 39(75.00) 其他 9(17.31) 8(15.38) 并发症 肝性脑病 4(7.69) 3(5.77) 0.000 1.000 肝肾综合征 6(11.54) 7(13.46) 0.088 0.767 腹水 16(30.77) 13(25.00) 0.430 0.512 脾功能亢进 9(17.31) 10(19.23) 0.064 0.800 食管胃底静脉曲张程度 0.150 0.881 轻度 14(26.92) 16(30.77) 中度 28(53.85) 25(48.08) 重度 10(30.77) 11(21.15) 
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表 2 2组患者疗效比较
例(%) 组别 例数 显效 有效 无效 总有效 观察组 52 26(50.00) 22(42.31) 4(7.69) 48(92.31) 对照组 52 24(46.15) 16(30.77) 12(23.08) 40(76.92) χ2 4.727 P 0.030
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表 3 2组患者输血量、大便潜血转阴时间比较
X±S 组别 例数 输血量/mL 大便潜血转阴时间/d 观察组 48 404.17±41.84 2.25±0.68 对照组 40 428.75±59.87 2.62±0.74 t 2.259 2.442 P 0.026 0.017 注：剔除止血无效者。
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表 4 2组患者营养指标比较
X±S 时间 组别 例数 ALB/(g·L-1) PA/(mg·L-1) Hb/(g·L-1) 治疗前 观察组 51 30.22±2.98 17.46±2.45 94.70±18.29 对照组 49 29.30±3.42 18.01±2.68 97.69±16.81 t 1.436 1.072 0.850 P 0.154 0.286 0.397 治疗后 观察组 51 32.38±3.411) 21.59±2.981) 113.92±19.281) 对照组 49 30.05±3.27 19.75±2.79 103.22±15.54 t 3.485 3.184 3.048 P 0.001 0.002 0.003 注：剔除治疗期间死亡者；与同组治疗前比较，1)P < 0.05。
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表 5 2组患者凝血功能比较
X±S 时间 组别 例数 PT/s APTT/s D-D/(mg·L-1) FIB/(g·L-1) 治疗前 观察组 51 13.47±1.95 35.64±2.84 1.26±0.46 2.13±0.65 对照组 49 14.00±1.73 34.79±2.53 1.31±0.41 2.30±0.73 t 1.436 1.578 0.573 1.231 P 0.154 0.118 0.568 0.221 治疗后 观察组 51 10.59±1.851) 30.65±2.521) 1.94±0.621) 3.05±0.871) 对照组 49 12.27±1.621 32.12±2.071) 1.63±0.571) 2.53±0.781) t 4.823 3.180 2.600 3.143 P < 0.001 0.002 0.011 0.002 注：剔除治疗期间死亡者；与同组治疗前比较，1)P < 0.05。
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表 6 2组患者免疫功能比较
X±S 时间 组别 例数 CD3+/% CD4+/% CD4+/CD8+ 治疗前 观察组 51 57.84±4.84 31.73±3.47 1.43±0.34 对照组 49 57.07±4.47 30.66±3.68 1.32±0.29 t 0.826 1.497 1.737 P 0.411 0.138 0.086 治疗后 观察组 51 62.97±4.141) 37.09±3.941) 1.79±0.401) 对照组 49 59.50±4.771) 35.07±3.351) 1.50±0.331) t 3.890 2.757 3.946 P < 0.001 0.007 < 0.001 注：剔除治疗期间死亡者；与同组治疗前比较，1)P < 0.05。
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