十二指肠溃疡患者夜间酸突破现象临床研究  

Clinical investigation into nocturnal acid breakthrough in patients with duodenal ulcer

作　　者：李骢[1] 姜铀[2] 李茹馨 姜春萌[2] 姜妙娜[4] 贾玉杰[4] 

机构地区：[1]本溪市本钢总医院氧疗中心,117000 [2]大连医科大学附属二院消化内科,116027 [3]鞍钢弓长岭矿业公司职工医院 [4]大连医科大学病理生理教研室,116027

出　　处：《中国实用内科杂志》2004年第12期725-727,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的　观察十二指肠溃疡患者夜间酸突破 (NAB)现象 ,以探讨不同治疗方案对NAB的控制效果。方法　将 2 0 0 2 - 0 6～ 2 0 0 3- 0 4大连医学院附属二院消化科 4 0例十二指肠溃疡患者随机分为 4组 ,每组 10例 ,A组 :口服奥美拉唑 2 0mg ,每日 2次 ,法莫替丁 2 0mg睡前口服 ;B组 :口服奥美拉唑 2 0mg ,每日 2次 ;C组 :口服奥美拉唑 2 0mg ,每日 1次 ,法莫替丁 2 0mg睡前口服 ;D组 :口服奥美拉唑 2 0mg ,每日 1次。用药 5d ,于第 5天监测 2 4h胃内pH值。结果　 (1)A组患者没有NAB发生 ,B、C组均分别只有 1例发生 ,D组发生 6例。A、B、C 3组显著低于D组 (P <0 0 5 )。 (2 ) 4组患者的平均胃内 pH值、平均中位pH、夜间平均胃内 pH、和夜间平均中位 pH比较 ,A组显著高于其他各组 (P <0 0 5 ) ;而B组与C组明显高于D组 (P <0 0 5 ) ,B、C组之间差异无显著性 ;D组各项指标均低于其他各组 (P <0 0 5 )。 (3)A组 pH <4 0的时间占总检测时间的百分比、夜间 pH <4 0的时间占夜间检测时间的百分比均显著低于其它各组 (P <0 0 1) ,而B组与C组均明显低于D组 (P <0 0 5 ) ,B、C组之间相比差异无显著性 ;D组明显高于其它各组 (P <0 0 5 )。结论　十二指肠溃疡患者治疗过程中单用奥美拉唑多发生NAB 。Objective To assess the incidence of nocturnal acid breakthrough (NAB) in patients with duodenal ulcer.Compare the different effects of different drugs and choose the best treatment method.Methods Forty duodenal ulcer patients were randomly allocated into four groups.Group A patients were treated with Omeprazole 20mg twice daily orally,plus famotidine 20mg at bedtime orally;group B took Omeprazole 20mg twice daily orally;group C took Omeprazole 20mg in the morning orally,plus famotidine 20mg at bedtime orally;and group D took Omeprazole 20mg once daily orally.All patients were treated for 5days.Intragastric pH over 24 hours was consecutively recorded on the fifth day for each patient and the status of H.pylori infection was also detected at the same time for all cases.Results 1.No NAB occurred in group A,1 patient occurred NAB in group B,1 patient in group C and 6 patients in group D(60%).The incidence of NAB in group A、B、C was significantly fewer than that in group D (P<0.05).2.The mean intragastric pH,median intragastric pH,nocturnal mean pH,and nocturnal median pH in group A were significantly higher (P<0.05)than those of other groups; group B and group C were significantly higher(P<0.05)than those of group D,but there was no significant difference between group B and group C.All the data of group D were significantly fewer (P<0.05)than those of other groups.3.The fraction time of pH below 4.0 for the whole day and at night in group A was significantly(P<0.01)fewer than other groups,and group B and group C were significantly(P<0.05)fewer than group D.There was no statistical difference between group B and group C. The data of group D were significantly higher(P<0.05)than those of other groups.Conclusion NAB usually occurres in patients with duodenal ulcer who are treated with Omeprazole only.The incidence of NAB can be decreased and the effect of suppressing intragastric acid can be improved by changing doses and methods of Omeprazole or combined using of Famotidine.

关 键 词：十二指肠溃疡 夜间酸突破现象 法莫替丁 奥美拉唑 用药剂量 

分 类 号：R573.1[医药卫生—消化系统]