危重症患者抑酸剂的选择

Selection of acid inhibitors for patients with critical condition

[目的]比较质子泵抑制剂和H2受体拮抗剂预防危重症患者应激性溃疡出血的疗效。[方法]将120例大连医科大学附属第一医院中心ICU的患者根据入科时急性生理和慢性健康（APACHEⅡ）评分分为A、B、C共3个治疗组,A组APACHEⅡ评分〈15分（30例）,B组APACHEⅡ评分〉20分（30例）,C组APACHEⅡ评分在15~20分之间（60例）。在积极治疗原发病的基础上,A组患者应用法莫替丁;B组患者应用泮托拉唑;C组患者随机分成C1、C2两个亚组（每组30例）,C1组抑酸剂同A组,C2组抑酸剂同B组。观察3组病例预防应激性溃疡出血的有效率。[结果]A组、B组、C1组、C2组预防应激性溃疡出血的总有效率分别为96.7%、86.7%、80.0%、96.7%,C1组、C2组两者间比较,差异有非常显著性意义（P〈0.01）。[结论]质子泵抑制剂预防危重症患者应激性溃疡出血的疗效优于H2受体拮抗剂,从经济疗效看应根据病情的严重程度选择不同的抑酸剂。

[Objective] To compare effects of proton pump inhibitor and H2 receptor antagonist for the prevention of stress ulcer bleeding（SUB） in patients with critical condition.[Methods] One hundred and twenty patients in center ICU from 2007 to 2009 were classified into 3 groups,according to APACHEⅡ.Those with APACHEⅡ less than 15 were in group A,over 20 were in group B,and between 15 and 20 were in group C.In addition,group C was random divided into C1 and C2 groups.Group A and C1 were treated with H2 receptor antagonist,group B and C2 were given with proton pump inhibitor.The preventive effect of stress ulcer bleeding（SUB） was compared among groups.[Results] For the prevention of SUB,effective power of group A was 96.7%,group B was 86.7%,group C1 was 80.0% and group C2 was 96.7%.Group C2 was higher than the C1 group（P0.01）.[Conclusion] Proton pump inhibitor is superior to H2 receptor antagonist for the prevention of SUB in critical patients.From economical perspective,the choice of acid inhibitor should be based on the severity of disease.