奥美拉唑对颅脑手术病人胃内pH的影响及对上消化道出血预防的临床研究

EFFECT OF OMEPRAZOLE ON THE INTRAGASTRIC pH AND THE PREVENTION OF UPPER GASTRONINTESTINAL BLEEDING IN PATIENTS RECEIVING BRAIN SURGERY

为观察奥美拉唑对颅脑手术病人胃内ｐＨ的影响，研究其对颅脑手术后上消化道出血的预防作用。作者将２０例颅脑手术病人随机分为两组，对照组１０ 例，术后予以常规治疗，奥美拉唑组１０ 例，术后除常规治疗外予以奥美拉唑４０ｍ ｇ 每日１ 次静脉推注。所有病人术前４ｈ 开始胃内７２ｈ ｐＨ监测，并记录有无呕血、黑便、输血及大便隐血试验阳性。发现颅脑手术病人术中胃内ｐＨ 明显升高（Ｐ＜ ０．０１），但术后胃内ｐＨ 显著下降（Ｐ＜０．０５）。奥美拉唑可阻断术后胃内ｐＨ下降，使术后胃内ｐＨ 高于术前（Ｐ＜ ０．０１），与对照组比，奥美拉唑组术后胃内ｐＨ明显升高（Ｐ＜ ０．０１）。术后对照组病人呕血２ 例、黑便１ 例、大便隐血阳性２ 例；奥美拉唑组仅１例出现大便隐血阳性。提示颅脑手术病人存在术后胃酸高分泌；奥美拉唑可抑制术后胃酸分泌。

The aim of the study was to investigate the effect of Omeprazole on the intragastric pH and the prevention of upper gastrointestinal bleeding in patients undergoing brain surgery. Twenty patients who received brain surgery were randomly divided into two groups. 72 hour intragastric pH monitoring was carried out in all these patients beginning 4 hours before the operation. After the operation, 10 patients in the control group received therapy, the other 10 patients in Omeprazole group received Omeprazole 40 mg intravenously once daily in addition to routine therapy. In brain surgery patients, the intragastric pH increased during the operation ( P <0.01) and then decreased significantly after the operation ( P <0.05). the level of intragastric pH in the patients of Omeprazole treatment group maintained a high level in postoperative period as compared with that before the operation ( P <0.01). in the Omeprazole group the postoperative intragastric pH was much higher that that in the control group ( P <0.01). Hematemesis (2/10), melena (1/10) and positive occult blood (2/10) were found in patients in control group in postoperative period while only 1 patient had positive occult blood test result in the Omeprazole treatment group. It suggests that there was hypersecretion of gastic acid in the brain surgery patients. Omeprazole could inhibit such gastric acid secretion in postoperative period and might be useful in the prevention of upper gastrointestinal bleeding in these patients.