危重病人24h动态胃内pH和胆汁反流监测的研究

A Study of 24 hour ambulatory acid and bilirubin measurements in critically ill patients

目的探讨危重病人胃内pH值变化及是否伴有胆汁反流,为应激状态下急性胃黏膜病变(AGML)的防治提供理论依据探讨。方法对收治重症监护病房(ICU)的30危重病人(观察组)利用便携式pH监测仪和Bilitec2000胆汁监测仪进行24h动态胃内pH值及胆汁反流监测,并观察抑酸剂对胃内pH值的影响。对照组为20例有上腹症状,胃镜诊断为胆汁反流性胃炎的的门诊病人。结果观察组好转20例、死亡8例,放弃抢救2例。发生AGML并出血2例。观察组胃内pH>4者17例、部分时间pH>4者13例,对照组所有病人仅部分时间pH>4,两组比较P<0.001。观察组pH<4时间(min)(151.4±382.6)明显少于对照组(1086.3±295.0)(P<0.001),观察组用抑酸剂的病人胃内pH值<4时间(11.6±28.4)明显少于未用抑酸剂者(291.10±51.05)。观察组胃内胆红素吸光值(abs)>0.14的时间(min()231.3±319.3)与对照组(341.9±273.9)差异无显著性(P=0.21)。结论危重病人胃酸分泌受抑制,胃内pH值增高,部分同时伴有胆汁反流。

[Objective] To explore the changes of intra-gastric acid and with or without duodenogastric reflux （DGR） in critically ill patients. [Methods] From April 2005 to April 2006, 30 critically ill patients （28 men 2 women, mean age （62.6±17.1） years, range 18 to 81 years） and 20 patients of bile reflux gastritis by endoscopic examination （7 men, 13 women, mean age （43.3±18.3） years, range 19 to 76 years） were enrolled, all subjects obtained 24 hour Ambulatory Acid and Bilirubin Measurements using antimony pH electrode and Bilitec 2000 with fiberopotic sensor. [Results] Of 30 critically ill patients, the percentage total time of intra-gastric pH〉4 was significant higher than that of patients of bile reflux gastritis （P 〈0.001）, The percentage total time of pH〉4 was significantly higher in the critically ill patients who received Acid-suppressing drugs （11 received proton pump inhibitor and 4 received H2-receptor antagonist） when compared with the patients of not received pH increasing substances （P 〈 0.05）. No statistically significant differences were found in the percentage total time of bilirubin absorbance （Abs） level〉0.14 between critically ill patients and bile reflux gastritis. [Conclusions] There is a clinically significant decreasing of gastric acid secretion and a clinically significant increasing of bile reflux in critically ill patients.