泮托拉唑对体外循环手术患者胃内酸碱度的影响

Effect of post-operation intravenous pantoprazole on intragastric pH in patients undergoing cardiopulmonary bypass

目的:研究接受体外循环手术患者胃内酸碱度(pH)值变化以及泮托拉唑对其影响。方法:2008年5月至2009年11月60例心脏疾病体外循环手术患者随机分为2组(A组:B组=2:1),A组(泮托拉唑组)术后2h、14h静注泮托拉唑40mg,B组(对照组)术后未用影响胃酸分泌药物。动态监测胃内pH值变化。结果:A、B组术前胃内pH值分别为2.41±1.11和2.60±1.01,术后返回监护室时胃内pH值分别为3.47±1.51和3.56±1.40均偏高,2组间差异无统计学意义(P<0.05;A组胃内pH值术后4h、12h、18h分别为6.03±1.81,6.01±1.58,6.34±1.28,相应的B组为3.54±1.11,2.94±1.30,2.65±1.24;2者差异有统计学意义。结论:体外循环心脏外科手术术后胃酸分泌被暂时抑制,但迅速恢复,术后静脉注射泮托拉唑可以持续使胃内pH值维持于较高水平,可能有利于防止应激性溃疡的并发症,也要考虑持续时间较长增加医院内获得性肺炎的可能。

Objective：To observe the change of intragastric pH in patients undergoing cardiopulmonary bypass and the effect of intravenous injection with pantoprazol on them.Methods：Sixty patients who were scheduled for cardiac surgery with CPB in Anzhen Hospital from May 2008 to November 2009 were randomly divided into two groups（Group A：Group B = 2：1）.Group A（n = 40） was treated with pantoprazole 40mg injection 2 and 14 hours after the operation respectively.Group B（n = 20） as the control group was not treated by any drugs that affected the intragastric pH.24 hour intragastric pH monitoring was carried out on each patient.Results：The intragastric pH pre-operation（Group A 2.41 ± 1.11,Group B 2.60 ± 1.01） and post-operation when returning to the ICU（Group A 3.47 ± 1.51,Group B 3.56 ± 1.40）of both Group A and B were elevated and had no significantly different.The values of 4 hours,12 hours and 18 hours post-operation,Group A were 6.03 ± 1.81,6.01 ± 1.58,6.34 ± 1.28,Group B were 3.54 ± 1.11,2.94 ± 1.30,2.65 ± 1.24.They were significantly different.Conclusion：Gastric acid secretion is temporarily inhibit in the immediate postoperative period following cardiac surgery with CPB.Intravenous pantoprazol can maintain the pH values in a relatively high level and may help to prevent the stress ulcer.But the possibility of developing nosocomial pneumonia needs for safety precaution if the treatment is long during.[