质子泵抑制剂治疗慢性阻塞性肺疾病并发呼吸衰竭患者上消化道出血的疗效评价

Therapeutic evaluation of proton pump inhibitor in the treatment of chronic obstructive pulmonary disease with respiratory failure complicated by upper gastrointestinal bleeding

目的探讨质子泵抑制剂在治疗慢性阻塞性肺疾病并发呼吸衰竭患者上消化道出血中的治疗价值。方法选择慢性阻塞性肺疾病并发呼吸衰竭患者103例,且均经大便隐血试验上消化道出血,将其分为观察组53例和对照组50例,两组均给予常规抗感染、纠正呼吸衰竭等基础治疗,观察组加用兰索拉唑30 mg,每天1次,静脉滴注,对照组加用法莫替丁40 mg,每天1次,静脉滴注,两组均连续使用1周,分别观察第5、7、14天大便隐血情况。结果观察组大便隐血情况分别为第5天10例,第7天5例,第14天0例;对照组大便隐血情况分别为第5天26例,第7天22例,第14天18例。观察组有效率[100.0%(53/53)]高于对照组[64.0%(32/50)],差异有统计学意义(P<0.05)。观察组总不良反应发生率[3.8%(2/53)]低于对照组[16.0%(8/50)],差异有统计学意义(P<0.05)。观察组患者好转率、病死亡、住院时间和气管插管率等转归情况均优于对照组(P<0.05)。结论质子泵抑制剂治疗慢性阻塞性肺疾病并发呼吸衰竭患者上消化道出血疗效好,能缩短住院时间,降低全组病死率,不良反应少,值得临床推广。

Objective To explore the therapeutic value of the proton pump inhibitor（PPI） in the treatment of chronic obstructive pulmonary disease （COPD） with respiratory failure complicated by upper gastrointestinal bleeding. Methods A total of 103 patients with COPD and respiratory failure complicated by upper gastrointestinal bleeding were selected and divided into observation group （n=53） and control group （n=50）. Both groups were given conventional anti-infection and correct treatment of res- piratory failure, meanwhile the observation group was added intravenously with 30 mg lansoprazole once daily, and the control group was added with 40 mg famotidine intravenously once daily for continuous 7 days. The fecal occult blood in the two groups on 5th,7th,and 14th day was observed. Results Fecal occult blood in the observation group appeared in 10 cases on 5th days,5 cases on 7th day and 0 case on 14th day;while the fecal occult blood in the control group appeared in 26 eases on 5th day, 22 cas- es on 7th day and 18 cases on 14 day. The effective rate in observation group[100.0%（53/53 ）] was higher than that in control group [64.0%（32/50）] with statistically significant difference （P〈O.05） ;while the adverse reaction rate in observation group[3.8% （2/53）] was lower than that in control group[16.0% （8/50）] with statistically significant difference （P〈0.05）. The observation group was better than control group on improvement rate, fatality rate,length of stay, endotracheal intubation rate and so on （P〈0.05）. Conclusion The efficacy of PPI in the treatment of COPD with respiratory failure complicated by upper gastrointestinal bleeding is good,and it can shorter hospital stays,reduce the whole fatality rate with fewer adverse reactions, so it is worthy of promotion and popularization in clinical.