奥美拉唑联合雷尼替丁治疗十二指肠溃疡的抑酸疗效分析  

The Efficacy of Combined Omeprazole and Ranitidine Therapy in Patients with Duodenal Ulcer

作　　者：樊力红[1] 李瑜元[1] 王红[1] 聂玉强[1] 戴寿军[1] 

机构地区：[1]广州医学院附属市一人民医院消化内科,广东广州510180

出　　处：《广州医学院学报》2006年第2期24-28,共5页Academic Journal of Guangzhou Medical College

摘　　要：目的:比较奥美拉唑(om eprazole,OME)不同剂量及联合雷尼替丁(ran itid ine,RAN)治疗十二指肠球部溃疡(duodenal unc ler,DU)活动期患者的抑酸效果,特别是对夜间酸突破(nocturnal ac id breakthrough,NAB)现象的控制,并探讨幽门螺杆菌(helicobacter pylori,HP)对抑酸疗效的影响。方法:病例选自经本院胃镜确诊为十二指肠球部溃疡活动期患者74例,随机分配入4个治疗组:A组,13例,OME 20 mg每天1次;B组,37例,OME 20 mg每天2次;C组,11例,OME 40 mg静脉推注,每12 h 1次;D组,13例,B方案联合RAN 150 mg睡前口服。在第5天对入组病人进行24 h胃内pH监测。结果:4组胃内24 h及夜间平均pH值、中位pH值、pH<4所占的时段百分比及NAB发生率(A组76.9%,B组24.3%,C组18.2%,D组7.7%)差异有显著性,其中,A组与B、C、D 3组差异有显著性(P<0.001);B、C、D 3组比较差异无显著性(P>0.05);同一治疗组内HP阳性者24 h及夜间平均pH值、中位pH值均高于阴性者,pH<4所占的时段百分比低于阴性者。HP阳性者NAB发生率低于阴性组(13.7%vs44.1%,P<0.05),而在4个治疗组内仅有A组内HP阳性者NAB发生率低于阴性者,其余3组HP感染与否对NAB发生率无影响。结论:OME抑酸疗效具有剂量依赖效应,联用RAN有减少NAB的趋势。HP感染者应用OME抑酸效果较好。Objective： To investigate the efficacy of varied doses of Omeprazole （OME） alone or in combination of Ranitidine （RAN） for acid secretion, especially the nocturnal acid breakthrough （NAB） in patients with active duodenal ulcer, and impacts of HP on the treatment efficacy. Methods： 74 patients with duodenal ulcer confirmed by gastroscopy were randomized to one of the four treatment groups： group A （omeprazole 20 mg daily, n = 13）, group B （omeprazole 20 mg twice a day, n = 37）, group C （omeprazole 40 mg iv per 12 hours, n = 11 ） and group D （receiving treatment as described in group B, with additional oral ranitidine 150 mg at bedtime, n = 13 ）. Twenty-four hour intragastric pH-metry was performed on day 5. Results： Significant differences in the mean and median values of 24h and night-time intragastric pH, percentage of hours below pH 4 as well as incidence of NAB （ group A = 76.9%, group B = 24.3%, group C = 18.2%, group D = 7.7% ） were found between group A and the other 3 groups （ P 〈 0. 001 ）, which showed no difference between one another （ P 〉 0.05 ）. Compared with HP-negative patients within a same treatment group, the mean and median values of 24h and night-time intragastric pH, percentage of hours below pH 4 were lower in those with positive HP results. The incidence of NAB was lower in HP-positive patients compared with hp-negative ones （ 13.7% vs 44. 1%, P 〈 0. 05 ）, and in all treatment groups, HP-positive patients experienced less NAB than those with negative HP. Infection with HP was not related to NAB in the other 3 groups. Conclusion： omeprazole therapy showed effects on acid suppression in a dose-dependent pattern. Combination of ranitidine tended to reduce the incidence of NAB. Patients with HP infection experienced better efficacy with OME therapy.

关 键 词：夜间酸突破 幽门螺杆菌 奥美拉唑 雷尼替丁 

分 类 号：R573.1[医药卫生—消化系统]