内镜与药物治疗对消化性溃疡并出血疗效与耗费对比

Clinical and economic outcomes of endoscopic and medical therapy on patients with peptic ulcer bleeding

目的 :观察不同的治疗方法 (内镜和药物 )对消化性溃疡并出血病人疗效与耗费的影响 ,以寻求效好价低的治疗溃疡出血的理想方案。方法 :将高龄 (>70岁 )、休克、严重伴随疾病及内镜下见活动出血表现的溃疡出血病人列为高危组 ,其余的列为低危组。高危组病人共 87例随机分为 2组 ,分别接受①内镜加药物联合治疗 ,内镜下对出血灶注射肾上腺素再加用每天 2次静脉注射质子泵抑制剂奥美拉唑 40mg共 5天 ;②单纯药物治疗 ,每天 2次静脉注射奥美拉唑 40mg共 5天。低危组病人共 15 6例随机分为 2组 ,分别接受①每天 2次静脉注射奥美拉唑 40mg共 5天 ;②每天2次静脉滴注H2 受体拮抗剂雷尼替丁 10 0mg共 5天 ;治疗期间观察病人的止血时间、输血量、再出血、手术、死亡情况及住院时间和住院总耗费。结果 :高危病人联合治疗组的再出血率 (9 5 % )、止血时间 (1 7± 1 9天 )、住院时间(10 1± 5 9天 )、误工费 (5 0 6 0± 2 95 6元 )较纯药物组明显低 (P <0 0 5 ) ;手术率、死亡率、输血量和住院总耗费则无显著性差异 (P >0 0 5 )。低危病人奥美拉唑和雷尼替丁组的再出血率、手术率、死亡率、输血量、住院时间和误工费之间无明显差异 (P >0 0 5 ) ;止血时间则奥美拉唑组 (1 6± 1 5天 )明显低 (P <0 0 5 ) ;

Objectives:To investigate the effect of different regimans on peptic ulcer bleeding(PUB)and to establish a cost effective guideline for the management of PUB Methods:87 peptic ulcer patients with old age (>70),shock,severe associated diseases and active bleeding or non bleeding visible vessel (Forrest Ⅰa、Ⅰb、Ⅱa、Ⅱb) under endoscopy were enrolled into high rish group;and the other 156 bleeding peptic ulcer patients were enrolled into low risk group Patients in high risk group were randomized divided into two regimens 1 Combination therapy:patients were given with endoscopic injection therapy,and then followed by a proton pump inhibitor (PPI) 40 mg omeprazole intravenous injection twice daily for 5 days 2 Medication therapy:patients were given with 40 mg omeprazole intravenous injection twice daily for 5 days Low risk patients were randomly enrolled into two regimens 1 Patients were given with 40 mg omeprazole intravenous injection twice daily for 5 days 2 Patients were given with 100 mg H 2 receptor antagonist (H 2RA) ranitidine intravenous infussion twice daily for 5 days Results:There were significant differences between two regimens in high risk groups in rebleeding rate(9 5%),hemostasis time (1 7±1 9 days) and hospital stay (10 1±5 9 days), P <0 05 The differences in the blood transfussion ,surgery rate,mortality rate and hospital cost were not significant, P >0 05 The rebleeding rate,surgery rate,mortality rate,blood transfussion and hospital stay were not significant between two therapies in low risk group, P >0 05 The hospital cost in the ranitidine group was significantly lower than that of omeprazole group, P <0 05 Conclusions:Combination therapy effectively reduced the rebleeding rate,hospital stay and hemostasis time for high risk patients of PUB For the low risk patients,H 2RA with lower cost had the similar effect to PPI It was the first choice for low risk PUB