不同pH值对消化性溃疡并出血疗效的影响

Effect of different pH on the treatment of bleeding peptic ulcer

目的：探讨不同ｐＨ值对消化性溃疡并出血疗效的影响，方法和结果：１临床和动物实验富血小板血浆（ＰＲＰ）中加入不同剂量的ＨＣｌ以改变其ｐＨ环境并测定其血小板聚集率。结果显示，随着ＨＣｌ量的增加，ｐＨ下降，血小板聚集率也降低，当ｐＨ＜６８时，血小板聚集率显著下降，用不同ｐＨ值的缓冲液冲洗大白鼠胃内活检伤口，测定其胃粘膜出血时间（ＧＭＢＴ），结果显示，当ｐＨ≥６０时，ＧＭＢＴ明显减少，约５７６±１８６秒。２胃内ｐＨ值监测连续４８小时监测胃内ｐＨ值，结果显示，甲氰米胍１６００ｍｇ静脉注射与奥美拉唑４０ｍｇ静脉注射，胃内ｐＨ值相仿，分别为５４±１３和５８±１３，逐步降低甲氰米胍用量，其ｐＨ值亦逐步下降，至８００ｍｇ时，胃内ｐＨ值为１５，基本无作用。３临床疗效观察回顾性分析３０３例应用雷尼替丁与３２６例应用奥美拉唑的溃疡出血病人，前者手术率与死亡率为７２８％和１９９％，后者为４９１％和１８４％。结论：ｐＨ值与血小板聚集率及ＧＭＢＴ密切相关，药物治疗溃疡出血成功的关键在于有效提高胃内ｐＨ值。

Aim:to discuss the effect of different pH on the treatment of bleeding peptic ulcer.Methods and Results:1.Clinical and laboratry experiment.Different dosage of HCl was added to platelet rich plasma(PRP) to change the pH level.Result:More dosage of HCl was added to and pH level decreased,more platelet aggeration decreased.Platelet aggregation decreases significiently when pH<6.8.Different pH buffer solutions were used to wash the wound in mouse's stomath,and the gstric mucosa bleeding time(GMBT) was tested.The result is that the GMBT decreases signficintly when the pH≥6 0 2 Intragastric acidity monitoring.Intragastric acidity was monitored continiously in patients with duodenol ulcer for 48-hour.When given as an intravenous injection with an routine dose(40mg/day),omeprazole has quickly inhibited the intragastric acidity,given consistently high pH level of 5.8±1.3 While cemitidine,when given as an intravenous injection with an extra high dose(1600mg/day),the pH level is 5.4±1.6.Acid secretion has shown to be inhibited similarlly to omprazole.When given with a routine dose (800mg/day),the pH level is 1.5. There is no effect of acid inhibiting.3.Clinical effect.303 peptic ulcer bleed ing patients were treated by H 2 receptor antagonist ranitidine and 326 peptic ulcer bleeding patients were treated by PPI omeprazole.They were anlysised retrospectly.The mortility and surgery rate were 1.84% and 4.91%,while in the group receiving ranitidine,the mortility and surgery rate were 1.99% and 7.28%. Conclusion:There is a closed relationship between pH and platelet aggregation and GMBT.The key to successfully treat peptic ulcer bleeding patients is to increase the intragastric pH.