The Effect of Pitressin and Glypressin in Variceal Bleeding – A Preliminary Clinical Trial

血管升壓素Glypressin及Pitressin在食道靜脈瘤出血治療之比較：初報

陳信成(Shinn-Cherng Chen) ； 林子堯(Zu-Yau Lin) ； 盧勝男(Sheng-Nan Lu) ； 莊萬龍(Wan-Long Chuang) ； 謝明裕(Ming-Yuh Hsieh) ； 王良彥(Liang-Yen Wang) ； 蔡榮發(Jung-Fa Tsai) ； 張文宇(Wen-Yu Chang)

《The Kaohsiung Journal of Medical Sciences》 6卷10期 (1990/10) Pp. 551-555

https://doi.org/10.6452/KJMS.199010.0551

摘要

食道靜脈瘤出血為肝門靜脈高壓及肝硬化常見之併發症，並常導致病人死亡。其治療可使用內科藥物治療，食道球壓迫，內視鏡硬化治療及經皮穿肝血管栓塞術或外科治療等。內科治療中血管升壓素為重要藥物之一，然常用之Pitressin 為極短效藥物，需點滴注射器控制速度，且有心臟血管副作用。另一較新之Glypressin 較為長效，直接靜脈注射即可，且副作用較少報告。本文以經急診入院之食道靜脈瘤出血之病例，分別給以兩種藥物比較其止血效果及副作用之情形。各病例均詳記其臨床分期。在12小時內止血，且在48 小時內未再出血者為治療成功；而治療6 小時仍大出血或12小時仍持續出血，或止血後在48小時內再度出血者視為治療失敗，加入其他療法。有些病人有多次食道靜脈瘤出血之症狀，在同一病人之不同次出血，分別給予Glypressin 及Pitressin 以觀察兩種藥物在同一病人之效果差別。結果在24次出血症狀中，Glypressin 及Pitressin 之止血效果分別為Glypressin6 / 11 ( 54 . 5 % ) , Pitressin7 / 13 ( 53 . 8 % ）。在6 例病人之18 次出血症狀之比較，同一病人不同次出血之兩種藥物之效果幾乎完全一樣。副作用方面仍以胸痛及腹痛最多，Pitressin 10 次而Glypressins 5次。Glypressin 副作用之次數雖較少，但仍有胸痛之情形發生，對心臟血管缺血之患者是否適用，仍需小心研究。結論為兩種藥物間之止血效果並無不同，GlyPressin 在臨床使用較簡單，Pitressin 雖較麻煩，但可隨時調整劑量，副作用雖Glypresshi 較少，仍需小心觀察。在臨床上可依需要而分別選擇使用。

並列摘要

Effects of hemostatic and various side effects were compared between glypressin and pitressin. Fifty-five episodes of esophageal variceal bleeding in 29 patients were studied. Although the glypressin group included more patients in Pugh¡¦s classification C than the pitressin group, the result of hemostasjs was not influenced. The effect of hemostasis was evaluated in 24 episodes receiving either glypressin or pitressin. The hemostatic effects of glypressin and pitressin were 6/11, 54.5% and 7/13, 53.8% respectively. Eighteen episodes in six patients, with multiple episodes, were used to observe the effect of these two drugs in the same person. No difference was observed. The number of side effects in the glypressin group and the pitressin group were 5 and 10 respectively. Although the side effects of glypressin might be fewer than those of pitressin, chest pain was observed in patients receiving glypressin treatment. The use of glypressin in the patients with cardiac diseases should be studied further. Glypressin is more convenient in clinical use. However, pitressin doses is easily modified. Both drugs might be selected in the control of variceal bleeding.

並列關鍵字

glypressin ； pitressin ； variceal bleeding