奥美拉唑配合胃腔降温治疗老年急性上消化道大出血疗效观察附45例报告

Observation on Combined Treatment of Omeprazole and Intragastric Decrease of Temperature in Aged Patients with Acute Upper Gastrointestinal Massive Bleeding: A Report of 45 Cases

急性上消化道大出血是老人急症之一。３年来我院收治４５例，年龄６０～９１岁，平均年龄７０３岁。３７例经纤维胃镜检查：消化性溃疡２４例；急性胃粘膜病变、糜烂性胃炎１０例；胃癌２例；肝硬化并食道静脉破裂１例。大部分病人由于出血量多，入院时多处于休克状态，病情危重，需及时抢救。在综合疗效法基础上，联合应用奥美拉唑及胃腔降温，疗效满意，成功率达９５６％，２４ｈ内大部分患者止血。其作用机理：奥美拉唑是质子泵抑制剂，抑制Ｈ＋Ｋ＋－ＡＴＰ酶活性，对胃酸分泌有强而持久的抑制作用，使血小板能很好地凝集形成凝血块，减少Ｈ＋回渗致胃粘膜产生糜烂和溃疡，有利于止血。胃腔降温也可抑制胃酶分泌，抑制胃蛋白酶活性及血块溶解；冰冻盐水加入去甲肾上腺素、凝血酶等局部应用。

Acute upper gastrointestinal massive bleeding is one of emergency diseases in aged patients. There were 45 cases admitted in our hospital during the last 3 years (July 1994-june 1997). Their age ranged form 60 to 91 years (average age 70.3 years). 37 cases of them received fibrogastroscopic examination and had following findings:peptic ulcer 24 cases, acute gastric mucosal lesion, erosive gastritis 10 cases, stomach cancer 2 cases, liver cirrhosis complicated rupture of esophagus vein only 1 case. In most cases, they were in severe shock caused by massive bleeding (loss of blood volume 1500 ml, Hb 70 g/L) at admission and needed a emergency treatment immediately. We used the combined treatment of omeprazole with intragastric decrease of temperature on the general therapies. The therapeutic effect was satisfying with a success rate more than 95.6%. The majority of cases revealed a hemostasis within 24 hrs. This mechanism is, that omeprazole as a inhibition agent of the proton pump, inhibites H +-K +- ATP ase activity and gastric acid secretion strongly and constantly, and platelets aggregate. Decreasing the temperature in stomach also inhibites gastric acid secretion, pepsin activity and thrombolysis as well. Local used ice plus noradrenaline and thrombin to the gastric mucosal lesion directly may play a synergetic effect in hemostasis.