大剂量质子泵抑制剂泵入联合内镜下止血治疗老年消化性溃疡出血

Treatment of elderly peptic ulcer bleeding with large doses proton pump inhibitors pumped and endoscopic hemostasis

目的：探讨老年消化性溃疡出血的治疗方案。方法选取2014年1至12月于我院住院的85例老年消化性溃疡出血的患者，随机分为两组，观察A组（42例），入院后即给予内镜检查，如果为出血性溃疡，即给予内镜下止血治疗，后给予质子泵抑制剂（PPI）静脉滴注bid5d；观察B组（43例），入院后给予大剂量PPI（80mg＋8mg/h）泵入治疗24h后，再行内镜检查，如果内镜发现为出血性溃疡，即给予内镜下止血治疗，后再予PPI泵入72h，观察1周，比较两组的快速止血率、溃疡的内镜下分级、内镜下治疗率及溃疡再出血率。结果观察A组具有较高快速止血率（100%），内镜下Forrest分级多为Ⅰa～Ⅱb（76.2%），高危溃疡率及内镜下治疗率（76.2%）明显高于观察B组（P＜0.01），但两组再出血率无统计学差异。结论内镜下止血治疗对老年消化性溃疡出血疗效肯定，具有安全、快速止血、低再出血率的特点，提高了内科治疗效果；但首先给予大剂量、高效PPI泵入也能得到良好的治疗效果，不仅可减少高危溃疡的发生率及内镜下治疗率，而且可以减少患者内镜下检查的时间、内镜带来的痛苦及检查的费用，也是一种理想的治疗方案。

Objective To investigate the treatment of elderly peptic ulcer bleeding.Methods As observed objects, 85 patients suffering from senile peptic ulcer bleeding were randomly divided into two groups, group A and group B. In group A, there were 42 patients who got endoscopy immediately after hospitalization. For some of them who were bleeding ulcers, the endoscopic hemostasis were put into use in first step, and then the intravenous proton pump inhibitors （PPI） bid 5days were next treatment. In group B, there were 43 patents who were given the large doses PPI pumped therapy for 24 hours after hospitalization. The following treatment was endoscopy, if there were some patients who were bleeding in ulcers, the endoscopic hemostasis were immediately given, and then gave the PPI pumped 72 hours. After one week observation, we compared the rapid hemostasis rate, endoscopic ulcer grading and ulcer rebleeding.Results In comparison, the patients in group A had high rate of rapid hemostasis （100%）, endoscopic grading was ForrestⅠa-Ⅱb （76.2%）, the high-risk ulcer rate and the endoscopic therapy （76.2%） were significantly higher than group B （P＆lt;0.01）, in contrast, there were no noticeable difference in rebleeding between two groups.Conclusion The hemostasia treatment under the endoscope is effectual, safe and low rebleeding rate to the elderly peptic ulcer bleeding, which CAN rise the therapeutic efficacy in department of internal medicine. However, given large doses at beginning and efficiently PPI pumped can also get good treatment effect, which not only can reduce the incidence of high-risk ulcer and endoscopic treatment, but also can reduce the time of the patients with endoscopic examination, the pain of endoscopy and the cost of inspection. So it is also a reasonable treatment.