Lipozyme secretion, inhibiting the secretion of gastrointestinal and pancreatic peptide hormones, is one of the preferred drugs for acute esophageal and gastric varicocele bleeding in cirrhosis, and is also used for the treatment of acute non-varicocele bleeding? The use of somatostatin can significantly reduce the surgical rate of patients with peptic ulcer bleeding and prevent the occurrence of early rebleeding. At the same time, the use of such drugs can effectively prevent the increase of the pressure gradient of the hepatic venous after endoscopic treatment, thereby improving the success rate of endoscopic treatment.

After intravenous injection of somatostatin, the peak concentration can be reached within 1    min, and the half-life is about 3   min, which is conducive to the rapid control of acute upper gastrointestinal bleeding in the early stage? Method of use: First dose of 250                                                                                                                                                                                                                       , Course of treatment 5    d? For high-dose (500     μg/h) somatostatin continuous intravenous pumping or infusion is chosen, which is better than conventional doses in improving the patient's visceral hemodynamics, controlling bleeding and improving survival rate? For difficult-to-control acute upper gastrointestinal bleeding, 250                                                                                                                                                                                                        

Octreotide is an artificially synthesized 8                                                                                                                                                                                                                                                        

4. Antibacterial drugs

In patients with acute varicose rupture and bleeding in cirrhosis, inflammatory edema of the gastric mucosa and esophageal mucosa are often present in active bleeding. The preventive use of antibacterial drugs can help stop bleeding, reduce early rebleeding and infection, and improve survival rate?

5. Vasopressin and its analogues

Including posterior pituitary, vasopressin, teripressin, etc. The efficacy of intravenous vasopressin has been confirmed in some clinical trials. It can significantly control varicose bleeding, but cannot reduce the mortality rate. There are many adverse reactions (ischemia of the heart and peripheral organs? Arrhythmia, hypertension, intestinal ischemia, etc.)? In clinical practice, many combinations of nitrate drugs reduce their side effects? However, in the treatment of acute upper gastrointestin hemorrhage, the adverse reactions of the use of posterior pituitary and vasopressin combined with nitrate drugs are still higher than those of using teripressin alone? In order to reduce adverse reactions, the time limit for continuous high-dose vasopressin intravenous veins should not exceed 24    h, the usage of posterior pituitary is the same as vasopressin: 0.2    ~0.4    U/min     Continuous venous pumping, up to 0.8     U/min During the treatment process, nitrate drugs should be combined with intravenous injection of nitrate drugs according to the patient's cardiovascular disease condition and response to the drug, and ensure systolic blood pressure >90         Hg. Terivapopressin is a synthetic vasopressin analog that can last and effectively reduce the hepatic venous pressure gradient, reduce portal venous blood flow, and has a small impact on systemic hemodynamics. The recommended starting dose of Terivapopressin is: 2    mg/4    h. After the bleeding stops, it can be changed to 2     /d, 1    mg/time, generally maintained for 5       d to prevent early rebleeding

The compression of the three-chamber dicystic tube can effectively control bleeding, but the recurrence rate is high, and there are complications such as inhaled pneumonia and tracheal obstruction. It is a first aid measure for major bleeding that is difficult for drugs to control, creating conditions for endoscopic or interventional surgery to stop bleeding? When airbag compression is performed, 8~24      h degass 1                                                                                                                                                                                                    �

Emergency endoscopy and treatment of endoscopy play an important role in the diagnosis of upper gastrointestinal bleeding? Risk stratification and treatment? Although experts unanimously believe that endoscopy should be completed as soon as possible for patients with acute upper gastrointestinal bleeding, and combination of drugs and endoscopy is the preferred treatment method at present, due to the different operating methods and conditions of each hospital, the time for completing emergency endoscopy cannot be completely unified? Please refer to the relevant guidelines for the digestive major to choose endoscopy treatment methods. For patients who cannot undergo endoscopy to be diagnosed with clear diagnosis, empirical diagnostic evaluation and treatment can be performed. For those who are negative for endoscopy, small entanglement examination? Angiography? Gastrointestinal barium contrast or radionuclide scanning can be performed?

Endoscopic treatment timing: Compared with 12                                                                                                                                                                                                                                                         

Patients who cannot control acute major bleeding should consider interventional treatment as soon as possible? Clinical recommendations can use drugs to stop bleeding during the waiting period of interventional treatment, and continuously intravenously injected somatostatin proton pump inhibitor to control bleeding, improve the success rate of interventional treatment, and reduce the incidence of rebleeding? Selective left gastric artery, gastroduodenal artery, splenal artery or pancreatic duodenal artery angiography, for contrast agent spillover or lesions, vasopressin or norepinephrine is dripped through vascular catheters, causing arterioles and capillaries to contract, and then stop bleeding. Ineffective patients can use gelatin sponge embolization.

Interventional treatment includes selective angiography and embolization (TAE)? Transjugate intrahepatic portal-body venous stent shunt (TIPS): It is mainly suitable for conservative hemorrhage treatment (drug? endoscopic treatment, etc.) The effect is not good? Varicocele rupture and bleeding after surgery or end-stage liver disease waiting for liver transplantation? Its characteristics are: it can significantly reduce portal venous pressure in the short term, compared with surgical physical physical shunt.

,TIPS                                                                                                                                                                                                                                                             �
Chapter completed!