儿童十二指肠溃疡并消化道出血的药物治疗及分析

Analysis of treatment of peadiatric duodenal ulcer and hemorrhage of gastrointestinal tract

目的:比较不同方法治疗儿童十二指肠溃疡(duodeual ulcer,DU)并消化道出血的疗效和幽门螺杆菌(helicobaterpylori,Hp)的根除率,并评价根除Hp在DU愈合中的作用。方法:77例DU并消化道出血伴Hp感染的患儿分两组治疗,A组患者45例:奥美拉唑0.8 mg/(kg.d),每12小时静脉滴注1次,3 d后改口服0.5 mg/(kg.d),疗程4周;B组患者32例:西米替丁20mg/(kg.d),每12小时静脉滴注1次,1周后改口服20 mg/(kg.d),疗程4周。前2周两组同时加服克拉霉素20 mg/(kg.d)和替硝唑10 mg/(kg.d)。结果:大便潜血转阴率A组91.11%,B组59.38%;溃疡愈合率A组91.11%,B组71.88%;Hp的根除率A组86.67%,B组65.63%;Hp根除者溃疡愈合率93.33%,未根除者溃疡愈合率47%。差异均有统计学意义(P<0.05)。结论:质子泵抑制剂奥美拉唑加两种抗生素组成的三联疗法治疗儿童DU并消化道出血疗效好、安全,根除Hp可以提高儿童DU的愈合率。

Objective To observe the effect of different therapy in the management of duodenal ulcer and hemorrhage of gastrointestinal tract and the eradieative rate of Helicobaeter pylori. Method Total 77 patients with pediatric Helicobacter pylori duodenal ulcer and hemorrhage of gastrointestinal tract were divided into 2 groups. Group A was treated with Omeprazole 0. 8 mg/（ kg · d ）, q12 h iv drop. After three days ,they were changed to peros 0. 5 mg/（ kg · d） ,for four weeks;group B with cimetidine 20 mg/（ kg · d ） ,q12 h iv drop. A week later ,they were changed to peros 20 mg/（ kg · d） ,for four weeks. Clarithromyein 20 mg/（ kg ~ d） and Tinidazole 10 mg/（ kg · d） were admindstered to both groups. Results The negative rate of fecal occult blood was 91.11% in group A,59. 38% in group B;91.11% of duodenal ulcer healing in group A,71.88% in group B;86. 67 % of Helieobaeter pylori in group A,65.63 % in group B were eradicated ;93. 33 % of the duodenal ulcer were cured in patients of Hehcobacter pylori eradicated, while 47% in uneradicated. The difference had statistical significance in the two groups （P 〈 0. 05 ）. Conclusion Proton pump inhibitor （Omeprazole） in combination with antibiotics has showed more efficient therapeutic effect. Helieobaeter pylori eradication can improve the pediatric duodenal ulcer cure rate.