Effects of somatostatin, octreotide and pitressin plus nitroglycerine on systemic and portal haemodynamics in the control of acute variceal bleeding.
To examine the haemodynamic effects of somatostatin (SS) and octreotide (OC) versus pitressin plus nitroglycerine (PN) in the control of variceal bleeding, 224 patients with acute oesophageal and gastric variceal haemorrhage were randomly divided into three groups and treated with SS, OC and PN; they also had their Doppler ultrasound parameters measured before, during and after treatment. The success rates of bleeding control in the SS (80.9%, 86.8% and 89.7%, p<0.001) and OC (75.3%, 80.8% and 84.9%, p<0.01) groups were significantly higher than in the PN group (51.8%, 59.0% and 65.1%) at 24, 48 and 72 hours respectively, and the average duration of SS (12.7 + 6.8 h) and OC (13.8 + 8.0 h) was significantly lower than that of PN (24.6 + 15.4 h, p<0.001). Side-effects of SS (7.4%) and OC (8.2%) were less than those of PN (41.0%, p<0.001 and p<0.01). The diameter of portal vein (PVD), velocity of portal vein (PVV), volume of portal blood flow (PVF) and hepatic artery pulsatility index (HA-PI) in all three groups decreased significantly during initial treatment, but recovered when treatment was stopped. Heart rate and cardiac output decreased significantly in patients treated with SS and OC; mean arterial pressure was unchanged. However, heart rate and mean arterial pressure increased, and cardiac output decreased, with PN. Somatostatin and octreotide were more effective than pitressin plus nitroglycerine in patients with acute variceal haemorrhage, with fewer side-effects, and may decrease PVF and portal vein pressure through reduction of cardiac output and dilatation of the visceral blood vessels.
Zhang
H B
HB
Department of Gastroenterology & Hepatology, the 4th Military Medical University, Xi'an, China.
Wong
B C Y
BC
Zhou
X M
XM
Guo
X G
XG
Zhao
S J
SJ
Wang
J H
JH
Wu
K C
KC
Ding
J
J
Lam
S K
SK
Fan
D M
DM
D000208:Acute Disease; D001127:Arginine Vasopressin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use; D015282:Octreotide / Q000627:therapeutic use*; D011168:Portal System / Q000503:physiopathology; D011169:Portal Vein / Q000000981:diagnostic imaging; D012044:Regression Analysis; D013004:Somatostatin / Q000627:therapeutic use*; D014463:Ultrasonography; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D014665:Vasodilator Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D014665:Vasodilator Agents; D001127:Arginine Vasopressin; D013004:Somatostatin; D005996:Nitroglycerin; D015282:Octreotide