消化性溃疡并出血生长抑素治疗研究

Effect of somatostatin treatment to patients with bleeding peptic ulcer

目的 观察生长抑素 (SS)对出血性十二指肠溃疡 2 4h胃内pH的影响及其对消化性溃疡出血的治疗效果。方法 ①十二指肠溃疡出血 16例随机分为SS组 ( 2 5 0 μg ,i.v,后 2 5 0 μg/h静滴 )和奥美拉唑组 ( 40mg ,i.v,后 8mg/h静滴 )行 2 4h胃内pH监测 ;②消化性溃疡活动性出血 (渗血或并血管显露 )随机分为治疗组 3 7例 (SS同上 ,用药到出血停止后 48h)和对照组 46例 (奥美拉唑 40mg,i.v,q12h ,5日 )。结果 ①二组pH平均数和中位数 ,以及 2 3h胃内pH >6 0和pH>7 0百分比间无显著差别。②治疗组止血率 ( 91 9% )显著高于对照组 ( 73 9% ) ,再出血率 ( 11 8% )明显低于对照组( 3 5 3 % )。手术和死亡率二组间无显著差异。结论 生长抑素有效抑制胃酸分泌 ,使出血性十二指肠溃疡达最佳止血胃内pH ;有效控制消化性溃疡的活动性出血而降低再出血。

Aim To assess the effect of somatostatin on 24 hours intragastic pH in patients with bleeding duodenal ulcer and its efficacy for the treatment of peptic ulcers with active bleeding. Methods ①Sixteen patients with bleeding duodenal ulcer were randomly assigned to receive either somatostatin (250μg/hr after a bolus of 250μg) or omeprazole(8mg/hr after a bolus of 40mg) for 24 hours. Intragastric pH was continuously recorded with a pH meter. ②83 ulcer patients with oozing bleeding or plus visible vessel by emergency endoscopy were treated with somatostatin or omeprazole. In the somatostatin group(n=37),250 μg was given as a bolus, then continuous infusion 250μg up to 48 hours after hemostasis. In the omeprazole group(n=46), intravenous injection of 40mg was given every 12 hours for 5 days. Results ①Both drugs rapidly raised intragastric pH above 6.0. There were no significant difference between two group about mean(6.9±0.39 vs. 6.8±0.41) as well as median intragastric pH(7.0±0.32vs. 7.0±0.38). The percentage of time spent above pH of 6 and 7 was similar with somatostatin and omeprazole. ② Somatostatin ceased further hemorrhage (91.9%) and prevented rebleeding (11.8%) more effectively than omeprazole (73.9% and 35.3%) ( P <0.05). The need for surgery and mortality did not differ significantly between two groups. Conclusion Infusion of somatostatin as well as omeprazole after a bolus produced consistently high intragastric pH value in patients with bleeding duodenal ulcer. Somatostatin can reduce the risk for continued bleeding and for rebleeding for peptic ulcers with active bleeding.