重型颅脑损伤后应激性溃疡出血的预防研究

Prevention of bleeding from stress ulceration after severe craniocerebral injures

目的 探讨重型颅脑外伤患者应激性溃疡出血的预防。方法 将16 9例重型颅脑外伤随机分为4组:无药物预防组、抑酸剂预防组、生长抑素预防组、联合预防组。比较各组对出血预防的效果,然后将各组分为出血组和未出血组。利用胃肠张力管检测不同时间pHi值,同时测定不同时段胃液pH值,研究其变化规律及与出血的关系。结果 联合用药对预防重型颅脑外伤应激性溃疡出血效果更加显著(P <0 .0 1)。联合用药处理未显示更强的抑酸效果。发生出血的患者入院时的pHi均值与未发生溃疡出血者无显著差异;入院后第12、2 4小时、第3、5、7天2组间均有显著差异。结论 监测pHi值对于重型颅脑外伤后应激性溃疡出血的发生具有预警作用,可指导临床治疗。

Objective To study the prevention of bleeding from stress ulceration afrer severe craniocerebral injures.Methods One hundred and sixty-nine patients with severe craniocerebral injures were divided randomly into 4 groups,and were treated respectively by Omeprazole,Somatostatin,Omeprazole plus Somatostatin and without special drugs.Then,the patients in each group were classified into the bleeding group and the non-bleeding group.Their different time pHis were determined with tonometry.The different time pH of gastric juice were also monitored.Results The bleeding preventing effects by Omeprazole plus Somatostatin was more effective as compared to other groups,meanwhile it did not cause the pH value of gastric juice to decrease further.On admission,the pHi was not significantly different between the non-bleeding group and the bleeding group,but the differences between two groups at 12h,24h,and on 3rd,5th day,the 7th day after admission were significantly marked,pHi in the bleeding group was statistically lower than that of non-bleeding group,meanwhile the pH values of gastric juice were not significantly different between the 2 groups during each therapeutic period.ConclusionpHi was predictive for bleeding from stress ulceration after severe craniocerebral injures.