选择性干预重型脑伤、脑出血患者胃液酸碱度预防消化道应激性溃疡出血的研究

Effectiveness of a selective intervention program targeting gastric juice acidity on preventing gastrointestinal bleeding due to stress ulceration in patients with severe brain injury or cerebral hemorrhage

目的探讨一种有效预防重型脑伤、脑出血患者消化道应激性溃疡出血的方法。方法通过对96例重型脑伤、脑出血患者胃液酸碱度(p H)监测,将p H值<4.0者随机分为A、B两组,p H值≥4.0分为C组,A组用胃内局部注入碳酸氢钠、氢氧化铝凝胶干预,维持p H值≥4.0,B组常规静脉用奥美拉唑制酸药物干预,C组不用任何药物干预,监测14 d,观察A、B、C组胃出血情况。结果 A组31例,p H值3.07±0.63,GCS 5.56±1.61,胃出血3例,出血率9.67%,B组32例,p H值3.27±0.47,GCS 5.88±1.43,出血14例,出血率为43.75%,C组13例,p H值5.07±0.68,GCS 4.33±0.84,无出血病例,A、B两组比较,差异具有统计学意义(P<0.01﹚。结论重型脑伤、脑出血引起消化道应激性溃疡出血的主要原因是胃酸过多,实施胃液p H值监测具有重要的临床意义。对胃液p H值<4.0的患者应尽早对胃内局部应用碳酸氢钠、氢氧化铝凝胶等碱性药物进行干预,能快速提高其胃液p H值,可显著降低其消化道应激性溃疡出血的发生率,明显优于静脉应用抑酸药物,对胃液p H值≥4.0的患者,因其出血率甚低,无需预防性应用制酸药物。

Objective To investigate an effective method to prevent gastrointestinal bleeding due to stress ulceration in patients with severe brain injury or cerebral hemorrhage. Methods The gastric juice acidity（pH） of 96 patients with se- vere brain injury or cerebral hemorrhage was tested. The patients were divided into group A （31 eases with pH 〈 4.0）, group B（32 cases with pH 〈4. 0） and group C（33 cases with phi〉4. 0）. In group A,sodium bicarbonate and aluminum hydroxide gel were injected in stomach to maintain pH 4. 0;in group B, antacid drug Omeprazole was given intravenous- ly;in group C, no drug was administrated. After the treatment of 14 weeks, the incidence of stomach bleeding was com- pared among group A, B and C. Results After the treatment, pH value in the Group A was 3.07 ＋ 0. 63, GCS was 5.56 ~ 1.61,3 cases were with stomach bleeding,bleeding rate was 9. 67% ;pH value in the group B was 3.27 ~ 0. 47, GCS was 5. 88 ~ 1.43,14 cases were with bleeding,bleeding rate was 43.75% ;pH value in group C was 5.07 ~ O. 68, GCS was 4. 33 ~ O. 84, there was no bleeding cases. Comparing with group A and group B, group C had significant statisti- cal significance（ P 〈 0. 01 ）. Conchlsion The main reason of gastrointestinal bleeding due to stress ulceration in patients with severe brain injury and cerebral hemorrhage is much gastric acid, so the implementation of gastric juice pH value de- tection has important clinical significance. The patients whose gastric juice pH value 〈 4. 0 should be conducted interven- tion to their partial stomach using sodium bicarbonate, aluminum hydroxide gel and other alkaline drugs as early as possi- ble,which can quickly improve their gastric juice pH value, significantly reduce the incidence of gastrointestinal bleeding due to stress ulceration, is superior to intravenous application of acid-suppression drugs obviously. For the patients whose gastric juice pH value 〉 4.0, the prophylactic application is not necessary.