别嘌呤醇对烧伤后应激性溃疡的防治作用

Effects of allopurinol on prevention and treatment of stress ulcer in burned patients

目的：观察临床上使用别嘌呤醇防治烧伤早期应激性溃疡的疗效。方法：选择烧伤面积大于30％的成人烧伤患者23例，随机分为别嘌呤醇组和西咪替丁组。烧伤早期分别服用别嘌呤醇和西咪替了；监测胃粘膜内pH（pHi）、胃液pH值、血清尿酸含量及纤维胃镜检查。结果：用药后别瞟吟醇组血清尿酸含量迅速下降，7日后达谷值〔（68．9土19．1）μmol／L，P＜0．001〕，明显低于西咪替丁组〔（277．6土43．3）μmol／L，P＜0．001〕，但别嘌呤醇组胃液PH升高幅度不大，低于西咪替丁组（P均＜0，05），而胃pHi值用药后明显升高，3日后达正常值范围，胃、十二指肠粘膜损伤指数明显降低，并与胃pHi值呈明显负相关（r=-0．92，P＜0．05）。结论：烧伤早期使用别嘌呤醇可明显改善胃粘膜细胞氧合，纠正细胞酸中毒，有利于粘膜损伤的恢复；别嘌呤醇临床疗效尤于西咪替丁。

Objective: To observe the therapeutic effects of allopurinol on stress ulcer in patients during early burns. Methods:Twenty-three adult patients with burns over 30% total body surface area were included in this study,and they were divided into allopurinol and cimetidine treatment groups. In-tramural pH (pHi) of stomach, the pH of gastric juice, serum uric acid contents were measured, and fiberoptic endoscopic examination was done during early postburn phase. Results: In allopurinol treated group,serum uric acid contents were significantly lower than that in cimetidine group on postburn day 7 [(68. 9±19. 1) μmol/L vs. (277. 6±43. 3)μmol/L, P<0.00l]. The pH in gastric juice in allopurinol group was significantly lower compared with the cimetidine group (all P<0.05),but pHi value marked-ly increased after administration of allopurinol and restored to normal range on postburn day 3. On the other hand, damage indexes of the gastric duodenal mucosa in allopurinal group were decreased, and they were negatively correlated to pHi value (r=-0. 92, P<0.05). Conclusions: The results suggestthat early use of allopurinal can improve the oxygenation in gastrib mucosal cells,resulting in ameliora-tion of mucosal damage. The curative effect of allopurinol is superior to that of cimetidine.