급성 식도정맥류 출혈 환자에서 Somatostatin과 Vasopressin의 치료효과 비교: A Prospective Randomized Trial.

Abstract

Background/ A ims : Although endoscopic band ligation or injection sclerotherapy are the current standard therapies for bleeding esophageal varices, the best method for initial control is unclear . The aim of this prospective study was to compare the efficacy and toxicity of somatostatin and vasopressin in the management of esophageal variceal hemorrhage. Methods : From March, 1997 to September , 1998, 28 consecutive cirrhotic patients admitted to the Yon sei Medical Center because of active variceal bleeding were included in this trial. The patient s were randomized to receive either somatostatin (15 patient s) or vasopressin (13 patient s) for 48 hours. Results : There were nosignificant differences between the two treatment groups in relation to Child' s classification, amount of bleeding before randomization and unit s of blood transfu sed during therapy . Initial control of bleeding was achieved in 13 (86.7%) patient s receiving somatostatin and in 10 (76.9%) of those treated with vasopres sin. However , two patient s in the somatostatin group and two in the vasopressin group bled again during treatment . Therefore complete control of bleeding during the 48 hour s of therapy was achieved in 11 (73.4%) patient s treated with somatostatin and in eight (61.5%) of those receiving vasopressin. Differences were observed in complication s associated with each therapy. Vasopressin produced complications in four patient s (chest pain in two, hyperten sion in one and hyponatremia- induced seizure in one) while somatostatin produced minor complication in one patient. Conclusions : This study suggest s that somatostatin is efficaciou s in controlling acute hemorrhage from esophageal varices and has a lower risk of adver se effect s than vasopres sin.(Korean J Hepatol 2000 ;6 :468 - 473)