雷贝拉唑对重症急性胰腺炎患者上消化道出血的预防作用

The Preventive Effects of Rabeprazole on Upper Gastrointestinal Tract Hemorrhage in Patients with Severe Acute Pancr eatitis

背景:重症急性胰腺炎(SAP)是一种临床常见的危重疾病,急性胃黏膜病变引起的上消化道出血是SAP较为常见的并发症。目的:观察雷贝拉唑对SAP患者上消化道出血的预防作用。方法:30例SAP患者随机分为两组,分别予雷贝拉唑20mg每日1次口服(n=20)和法莫替丁40mg每日2次静脉滴注(n=10),疗程1周。于用药前24h至用药后72h连续监测上消化道出血的发生情况和胃内pH的变化。结果:雷贝拉唑组患者无呕血和黑粪出现,法莫替丁组有1例患者出现黑粪,发生率为10%。用药后,两组患者的胃内pH和pH>3、pH>4、pH>5的时间百分比均显著升高,雷贝拉唑组升高较法莫替丁组显著(P<0.05)。两组患者均未发生明显不良反应。结论:雷贝拉唑和法莫替丁均能升高SAP患者的胃内pH,对上消化道出血有预防作用,且无明显不良反应。雷贝拉唑维持胃内较高pH的时间较法莫替丁更长。

Background:Severe acute pancreatitis(SAP)is a common critical illness in clinics,and hemorrhage of upper gastro-intestinal tract caused by acute gastric mucosal lesion is a frequent complication of SAP. Aims: To evaluate the effects of rabeprazole on prevention of upper gastrointestinal tract hemorrhage in patients with SAP.Methods:Thirty patients with SAP were randomly divided into two groups:rabeprazole group(n=20),rabeprazole20mg once daily given orally for one week;famotidine group(n=10),famotidine40mg twice daily given intravenously for one week.The bleeding events in the upper gastrointestinal tract and intragastric pH were monitored continuously from24hours before giving the medication till72hours after administration.Results:No hematemesis or melena was observed in rabeprazole group,and one patient had melena in famotidine group,the prevalence rate was10%.After medication,the intragastric pH,and the time percentages of pH>3,pH>4and pH>5were elevated significantly in both groups,the elevation was much higher in rabeprazole group than that in famotidine group(P<0.05).No significant side-effect was found in both groups.Conclusions:Both rabeprazole and famotidine can raise the intragastric pH and prevent the upper gastrointestinal tract hemorrhage without causing side-effect in patients with SAP.The intragastric pH raised by rabeprazole is more prolonged than that by famotidine.