脑卒中后应激性溃疡夜间酸突破现象的研究  

Nocturnal acid breakthrough in post-stroke stress ulceration

作　　者：张晓苹[1] 赵宏军[2] 马阿火[1] 吴承龙[2] 傅文安[1] 

机构地区：[1]浙江省绍兴市人民医院消化内科,浙江绍兴312000 [2]浙江省绍兴市人民医院神经内科,浙江绍兴312000

出　　处：《中国实用内科杂志》2010年第11期1013-1015,共3页Chinese Journal of Practical Internal Medicine

基　　金：绍兴市重点科技计划(2008A23002)

摘　　要：目的观察脑卒中后应激性溃疡(SU)夜间酸突破(NAB)现象,探讨不同治疗方案对NAB的控制效果及SU的发生率及患者的病死率。方法将2007年10月至2009年10月.浙江省绍兴市人民医院收治的急性脑卒中患者100例随机分为3组。A组:静脉滴注奥美拉唑40mg,每日2次;B组:口服(或胃管内灌注)奥美拉唑片40mg,每日1次;C组:静脉滴注奥美拉唑40mg每日2次+静脉滴注西咪替丁600mg每晚1次。并于第6天早上监测24h胃内pH值。结果 (1)C组NAB显著低于A,B组(P<0.01),B组显著高于A,C组(P<0.01);(2)3组患者平均pH值及中位pH值、夜间胃内平均pH值及中位pH值、24h胃内平均pH<4时段所占时间百分比、夜间胃内pH<4时段所占时间百分比的比较,C组显著高于B组(P<0.01),A组明显高于B组(P<0.05)。(3)SU的发生率及病死率:C组低于A、B组,A组低于B组(P均<0.05)。结论改变奥美拉唑用药次数、剂量及联用西米替丁可以降低NAB的发生,有利于SU的预防及脑卒中患者的预后。Objective To observe nocturnal acid breakthrough （NAB） in post-stroke stress ulcer （SU）, and to explore the effects of various therapeutic regimens on NAB control and patient mortality. Methods 100 patients with acute stroke,who were admitted to Shaoxing People＇s Hospital during October 2007 to October 2009, were randomly allocated into three groups. Group A received intravenous injection of 40 mg Omeprazole twice daily, Group B received 40 mg Omeprazole once daily by oral use or through gastric tube, and Group C received intravenous injection of 40 mg Omeprazole （twice daily） plus 600 mg Cimetidine qN. 24-hour intragastric pH test was performed on the sixth day. Results （ 1 ） NAB in group C was significantly lower than that in groups A and B （ P 〈 0. 01 ）, and that in group B was significantly higher than groups A and C （ P 〈 0. 01 ） ; （ 2 ） Groups C and B had greater values of mean intragastrie pH, median intragastric pH, nocturnal mean pH, noctrunal median pH, and longer time with pH below 4.0 during 24-hour and at night, than group B （P 〈 0. 01, P 〈 0.05 ）. （3）The incidence and mortality of stress ulceration ： those in group C were lower than groups A and B, and those in group A were lower than group B （ P 〈 0.05 ）. Conclusion The incidence of NAB may be reduced by more frequenct use and higher dose of omeprazole, or by combining with Cimetidine, when can benefit prevention of SU and prognosis of stroke patients.

关 键 词：应激性溃疡 脑卒中 夜间酸突破 奥美拉唑 西咪替丁 

分 类 号：R5[医药卫生—内科学]