大剂量奥美拉唑防治应激消化道黏膜损伤的研究

Study on the prevention effects of high.dose omeprazole in the treatment of stress-related mucosal injury

目的探讨持续静脉注射大剂量奥美拉唑防治重症患者并发应激性消化道黏膜损伤的疗效。方法选取2006年8月至2008年10月山东大学附属省立医院的重症监护室的并发应激性消化道黏膜损伤的98例危重症患者，随机分为大剂量奥美拉唑组（A组）和对照组（B组）。A组首剂5min内静脉推注80mg奥美拉唑，后8．0mg/h静脉泵入，72h；B组40mg／h静脉滴注奥美拉唑，1次／8h，1次／72h。两组患者均定期用pH试纸检测条监测胃液pH值，观察胃肠减压器中是否有咖啡色或红色引流物。全自动血细胞分析仪监测血红蛋白、全自动生化分析仪测定血尿素氮、动脉血气分析仪测定动脉血碱剩余。两组之间均数比较用t—test，发生率用χ^2检验。结果治疗4h后，A组胃液pH值较B组升高[（6．63±0．62）vs．（3．14±0．26），P〈0．01]，治疗8h，16h及24h，胃液pH值也均高于B组（P〈0．05或P〈0．01）。治疗后8h，24h，A组血红蛋白高于B组、血尿素氮低于B组、动脉血碱剩余负值低于B组（P〈0．05或P〈0．01）。A组的胃肠道止血总有效率高于B组（95．35％vs．78．19％，P〈0．05）。结论重症患者并发应激性消化道黏膜损伤，大剂量奥美拉唑治疗效果优于常规给药。

Objective To study the therapeutic effects of omeprazole in high-dose given by continuous intravenous infusion in the treatment of stress-related mucosal injury of G-I tract in intensive care patients. Method Totally 98 intensive care patients with stress-related mucosal injury（SRMI） were enrolled from August 2006 to October 2008 Department in Intensive Care Unit（ICU） of the Provincial Hospital Affiliated to Shandong University. All the patients were randomly divided into high-dose omeprazole group （group A） and control group （group B）. In group A, omeprazole was administrated in loading dose of 80 mg I.V. in 5 minutes followed by maintenance dose of 8.0 mg/h intravenous infusion for 72 hours, while in group B, omeprazole was given in dose of 40mg/8h intravenous infusion for 72 hours. The pH value of gastric juice was determined by German Roche pH test paper every 2 to 8 hours in the patients of both groups. The coffee like or red juice in the gastrointestine decompressor was observed. At the same time, hemoglobin（HB） was detected by Automatic blood cell analyzer Sysmex XE- 2100, blood urea nitrogen（BUN） was determined by Automatic Analyzer Au5400, and buffer excess（BE） was checked by GEM Premie arterial blood gas analyzer in all patients. Data were expressed as mean ± standard deviation （x ^-± s） and the analysis of variance was done with SPSS 12.0 software. Comparison of mean value between two groups was conducted with t -test and the ratio was calculated by using chi-square test （ χ^2 test）. The change was considered as statistically significant if P value was less than 0.05. Results Four, eight, and 24 hours aftertreatment with omeprazole, the pH values in patients of group A were higher than those in patients of group B（four hous ： 6.63 ± 0.62 vs. 3.14 ±0.26, P 〈 0.01 ; eight hours and 24 hours ： P 〈 0.05 or P 〈 0.01 ）. At 8 hours and 24 hours after treatment, the HB was higher, BUN and BE were lower in group A than those in group B （ P 〈 0.05 or P 〈0.01）.The total rate of hemostasis of upper G-I tract bleeding in group A was higher than that in group B （95.35% vs. 78.19%, P 〈0.05）. Conclusions For treating the intensive care patients with SRMI, the continues intravenous infusion of omeprazole inhigh dose is superior to conventional dosage.