Intravenous Drip of Somatostatin Followed by Restricted Fluid Resuscitation to Treat Upper Gastrointestinal Bleeding in Patients with Liver Cirrhosis

Objective. Liver cirrhosis is a common, often progressive, and usually fatal disorder. Upper gastrointestinal bleeding is a leading cause of death in patients with liver cirrhosis. The purpose of this study was to evaluate the effectiveness of somatostatin combined with restricted fluid resuscitation in the treatment of upper gastrointestinal bleeding in the patients with liver cirrhosis. Methods. From January 2018 to December 2020, 84 patients with liver cirrhosis complicated by upper gastrointestinal bleeding admitted to the Department of Gastroenterology of Ningbo Yinzhou No. 2 Hospital were selected as study participants. They were randomly assigned into the study group (n = 42) and control group (n = 42). All patients were given intravenous drip of somatostatin. The study group was supplemented with restricted fluid resuscitation therapy. The hemoglobin (Hb), platelet, fibrinogen, hematocrit, transfusion volume of red blood cells, hemostatic time, hemostatic rates in 0 h–24 h, 24 h–48 h, and >48 h, rebleeding rates, resuscitation rate, and incidence rates of complications were compared between the two groups 48 h after treatment. Results. It was found that the Hb, platelet, fibrinogen, and hematocrit were notably increased in the study group compared to the control group 48 h after treatment P < 0.01 . The proportion of patients with excellent response was notably higher in the study group than in the control group P < 0.05 . The overall response rate of the study group was 90.48%, which was significantly higher than 71.43% in the control group P < 0.05 . The study group had lower transfusion volume of red blood cells, shorter hemostatic time, and lower rebleeding rates than the control group P < 0.01 . The hemostatic rate of 0 h–24 h in the study group was remarkably higher than that in the control group P < 0.05 . The hemostatic rate of >48 h in the study group was lower than that in the control group P < 0.05 . The overall incidence rate of complications in the study group was 9.52%, which was significantly lower than 30.95% in the control group P < 0.05 . Conclusion. These data suggest that intravenous drip of somatostatin followed by restricted fluid resuscitation leads to a better clinical efficacy in treating upper gastrointestinal bleeding in patients with liver cirrhosis considering higher resuscitation rate and hemostatic rate and reduced incidence of complications, which is conducive to the recovery of patients and worthy of further clinical promotion.

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Upper gastrointestinal bleeding in patients with liver cirrhosis

Zeitschrift für Gastroenterologie ◽

10.1055/s-0031-1278507 ◽

2011 ◽

Vol 49 (05) ◽

Author(s):

E Schafer ◽

K Rusznyák ◽

Z Visnyei ◽

K Dunkel ◽

B Tolmácsi ◽

...

Keyword(s):

Liver Cirrhosis ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Upper Gastrointestinal

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Nonvariceal upper gastrointestinal bleeding in patients with liver cirrhosis. Clinical features, outcomes and predictors of in-hospital mortality. A prospective study

Annals of Hepatology ◽

10.1016/s1665-2681(19)31540-6 ◽

2011 ◽

Vol 10 (3) ◽

pp. 287-295 ◽

Cited By ~ 29

Author(s):

José Alberto González-González ◽

Diego García-Compean ◽

Genaro Vázquez-Elizondo ◽

Aldo Garza-Galindo ◽

Joel Omar Jáquez-Quintana ◽

...

Keyword(s):

Liver Cirrhosis ◽

Gastrointestinal Bleeding ◽

Hospital Mortality ◽

Prospective Study ◽

Clinical Features ◽

Upper Gastrointestinal Bleeding ◽

A Prospective Study ◽

Upper Gastrointestinal

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1039 Mortality From Non Variceal Upper Gastrointestinal Bleeding in Patients With Liver Cirrhosis: an Individual Patient Data Meta-Analysis

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2013.04.150 ◽

2013 ◽

Vol 77 (5) ◽

pp. AB180 ◽

Cited By ~ 1

Author(s):

Riccardo Marmo ◽

Mario Del Piano ◽

Livio Cipolletta ◽

Maurizio Koch ◽

Enzo Grossi ◽

...

Keyword(s):

Liver Cirrhosis ◽

Gastrointestinal Bleeding ◽

Individual Patient Data ◽

Upper Gastrointestinal Bleeding ◽

Meta Analysis ◽

Patient Data ◽

Upper Gastrointestinal

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Clinical judgment model-based nursing simulation scenario for patients with upper gastrointestinal bleeding: A mixed methods study

PLoS ONE ◽

10.1371/journal.pone.0251029 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251029

Author(s):

AeRi Jang ◽

Hyunyoung Park

Keyword(s):

Mixed Methods ◽

Gastrointestinal Bleeding ◽

Clinical Judgment ◽

Upper Gastrointestinal Bleeding ◽

Mixed Methods Study ◽

Control Group ◽

Self Confidence ◽

Nursing Simulation ◽

Simulation Scenario ◽

Upper Gastrointestinal

Assisting patients with upper gastrointestinal bleeding is a crucial role for nurses, and as future nurses, students should demonstrate sound clinical judgment. Well-structured, high-quality simulations are useful alternatives to prepare students for clinical practice. However, nursing simulation scenarios focused on enhancing clinical judgment in managing upper gastrointestinal bleeding are limited. This study aims to develop, apply, and evaluate an effective nursing simulation scenario for patients with upper gastrointestinal bleeding based on Tanner’s clinical judgment model using a mixed methods study design. A high-fidelity patient simulation was conducted among 80 undergraduate nursing students divided into a simulated control group (n = 39) and an experimental group (n = 41). Subsequent student performance evaluations used questionnaires and video recordings. After scenario simulations, the students showed a statistically significant increase in theoretical knowledge (p = 0.001) and clinical performance skills (p < 0.001), but there was no significant increase in self-confidence (p = 0.291). According to the video analysis, the “noticing” clinical judgment phase was the most frequently observed phase, while “reflection” was the least frequently observed phase. Additionally, “education” was the most frequently observed nursing domain, and “anxiety” was the least frequently observed domain. Although further simulation repetitions are required to reinforce students’ self-confidence when caring for patients with upper gastrointestinal bleeding, the scenario was deemed effective. Moreover, emphasis should be placed on developing various scenarios to strengthen students’ clinical judgment skills, especially “reflecting” and “emotional care.”

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Histoacryl glue injection without lipiodol dilution and post sclerotherapy bleeding; prevalence among patients with upper GIT bleed.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.06.3982 ◽

2020 ◽

Vol 27 (06) ◽

pp. 1182-1186

Author(s):

Muhammad Ayub ◽

Sagheer Hussain ◽

Salman Ahmed

Keyword(s):

Liver Cirrhosis ◽

Gastrointestinal Bleeding ◽

Upper Gastrointestinal Bleeding ◽

Gastric Varices ◽

Recurrent Bleeding ◽

Endoscopic Sclerotherapy ◽

Ulcer Disease ◽

Acute Upper Gastrointestinal Bleeding ◽

Glue Injection ◽

Upper Gastrointestinal

Objectives: To determine role of histoacryl injection in preventing upper acute upper gastrointestinal bleeding. Study Design: Prospective Study. Setting: Gastroenterology ward of DHQ Teaching Hospital Gujranwala. Period: One year from 1st September 2017 to 31st August 2018. Material & Methods: Patients presented to the study hospital having upper gastrointestinal bleeding of acute onset due to gastric varices bleeding were included in this study. All other cases having upper GIT bleeding due to other causes like peptic ulcer disease, Mallory weise syndrome, gastritis or esophageal varices were not included in this study. Both male and female patients were included irrespective of their age. Hemostasis in these cases was achieved by endoscopic sclerotherapy using histoacryl glue (N-butyl-2-cyanoacrylate) injection without lipoidal dilution. After first session of injection patients were called on follow up after 5 days and they were assessed for recurrent GIT bleeding and treatment failure. All data was documented on a predesigned performa. Frequencies and percentage were calculated and results were expressed in tabular form and graphs. Results: Total 80 cases were studied including 56% male and 44% female cases. Endoscopic sclerotherapy using histoacryl injection proved successful in 87.5% cases and recurrent bleeding occurred in 12.5% cases. Minimum age of patients was 25 years and maximum age 70 years with mean age of 45 years. Total 450 cases presented in study institution with Upper GIT bleeding during study period and causes among them were liver cirrhosis in 92% cases, peptic ulcer disease in 4% cases, Malloryweise Syndrome in 2.5% and gastritis in 1.5% cases. In our study group cause of gastric varices was liver cirrhosis due to viral hepatitis in 73% cases and alcoholic hepatitis in 27% cases. After single session of endoscopic histoacryl glue injection to 80 cases, no bleeding occurred after 5 days in 71(88.7%) cases, recurrent bleeding occurred within 5 days in 9(11.2%) cases. Two cases died due to massive recurrent bleeding and mortality rate was 2.5%. Conclusion: Endoscopic sclerotherapy using Histoacryl injection is very successful treatment for acute upper gastrointestinal bleeding with very low recurrence rate of bleeding and low mortality rate.

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