两种剂量奥美拉唑静脉滴注预防危重患儿消化道出血的疗效比较

The Effect of Two Doses of Intravenous Drip Omeprazole Prevention Critically Ill Children with Gastrointestinal Bleeding

目的:比较静脉滴注0.5 mg/kg和1.0 mg/kg两种剂量奥美拉唑对危重患儿胃内pH、消化道出血及不良反应的影响。方法:选取2011年2月至2014年12月我院儿科综合重症监护室消化道出血危重患儿64例,随机分为A、B两组各32例,A组患儿静脉滴注0.5 mg/kg奥美拉唑,B组患儿静脉滴注1.0 mg/kg奥美拉唑,观察患儿用药后48 h内的胃内pH、pH>4的时间百分比及不良反应等。结果:奥美拉唑治疗后患儿胃内pH>4的时间占研究总时间的57.8%;两组患儿24~48 h胃内pH>4的时间百分比及平均胃内pH均明显高于0~24 h(P<0.01);B组24~48 h胃内pH>4时间百分比明显高于A组(P<0.05);B组患儿血浆奥美拉唑水平高于A组,但B组患儿血浆奥美拉唑水平和胃内pH无明显相关性。结论:静脉滴注0.5 mg/kg和1.0mg/kg两种剂量奥美拉唑在24 h内对胃内pH均未实现足够的碱化。对于24~48 h胃内pH>4时间百分比,1.0 mg/kg剂量组明显高于0.5 mg/kg剂量组。

Objective： To compare the effect of intravenous 0.5 mg/kg versus 1.0 mg/kg omeprazole on gastric pH, gastrointestinal bleeding and adverse effects in critically ill children. Methods： Sixty four children in the pediatric intensive care unit （PICU） of our hospital at risk of gastrointestinal bleeding from February 2011 to December 2014 were chosen in this study, and randomly divided into group A and B, each group with 32 cases. Children in group A received intravenous 0.5 mg/kg omeprazole, and those in group B received intravenous 1.0 mg/kg omeprazole. The gastric pH values during the 48 hours, percentage of time with gastric pH 〉4 and adverse reactions were recorded. Results： The percentage of time of the gastric pH was greater than 4 was 57.8%. The percentage of time with gastric pH〉4 and mean gastric pH at 24 to 48 hours were significantly higher than those at 0 to 24 hours （P〈0.01）. But for the percentage of time with gastric pH〉4 at 24 to 48 hours, group B was obviously higher than group A （P〈0.05）. Plasma omeprazole levels were higher in group B than in group A, but no correlation was found between omeprazole levels and gastric pH. Conclusion： Intravenous 0.5 mg/kg and 1.0 mg/kg omeprazole are not achieved adequate alkalinization of gastric pH during the first 24 hours. The percentage of time with gastric pH〉4 at 24 to 48 hours in 1.0 mg/kg dose group is significantly higher than that in 0.5 mg/kg dose group.