三联疗法根除幽门螺杆菌预防消化性溃疡再出血

Clinic study on eradication of helicobacter pylon with triple therapy prevent the rate of rebleeding in peptic ulcer hemorrhage

目的：探讨根除HP能否减少溃疡并发出血的发生率。方法：108例住院十二指肠溃疡出血患者，接受保守治疗以及以往有出血病史者组成该研究，全部患者经急诊内镜检查证实为HP阳性十二指肠溃疡，患者随机分为A组（奥美拉唑20mg，每日2次，羟氨苄青霉素0.5每日4次，甲硝唑0．2每日3次，共2周）；B组单用奥美拉唑20ma每日2次，共2周。第二次胃镜于完成治疗后4周及随访1年，再一次胃镜于1年末。结果：所有患者在完成治疗后4周溃疡愈合，A组和B组HP根除率分别为86．7％和10．4％（P＜0．001），A组溃疡复发（6／60或10％）显著低于B组（21／48或43．8％，P＜0．05）。三联疗法再出血发生率显著低于单一治疗组（0／60对10／48或20．8％，P＜0.01）。十二指肠溃疡出血患者的再出血和溃疡复发在HP根除者显著减少。结论：三联疗法应作为十二指肠溃疡患者中常规应用。

Objective: To examine whether eradication of HP has any impact on the complications of ulcers, such as bleeding. Methods: 108 patients hospitalized for duodenal ulcer bleeding, undergoing conservative treatment and with a previous history of bleeding, comprised the group studied. All patients had emergency endoscopy, and tests for HP proved to be POSitive in all. Patients were randomly assigned to receive omeprazole 20mg bid, amoxycillin 0. 5 qid, metronidazole 0. 2 tid (group A) for two weeks or omeprazole alone, 20mg bid (group B) for two weeks. Patients underwent a second endoscopy four weeks after completion of therapy and were followed for one yeal. Endoscopy was performed again at the end of one year. Results: All patients showed ulcer healing four weeks after completion of therapy. HP eradication rates were 86. 7 % (group A) and 10. 4 % (group B) (P< 0. 001 ). Ulcer recurrences were significantly lower in group A (6/60 or 10 % )than in group B (21/48 or 43. 8 %; P<0. 05). Rebleeding occurred significantly less often in the triple therapy group than in the omeprazole group (0/60 versus 10/48 or 20. 8 % ) (P< 0. 01). Conclusion: Eradication of HP significantly reduces the rate of ulcer recurrence and rebleeding in patients with duodenal ulcer bleeding. Triple therapy should be considered in all HP-positive patients with hemorrhage from duodenal ulcers.