围术期奥美拉唑预防高血压脑出血、重型颅脑损伤后急性应激性溃疡的疗效观察  

Effect of prophylactic omeprazole on stress ulcer after hypertensive intracerebral hemorrhage and severe brain injury

作　　者：范丹[1] 蒋蓉[1] 谢先丰[1] 许婷[1] 兰志勋[1] 

机构地区：[1]四川省人民医院麻醉科,成都市610072

出　　处：《临床麻醉学杂志》2010年第10期863-865,共3页Journal of Clinical Anesthesiology

基　　金：四川省卫生厅科研项目(303005002178004)

摘　　要：目的探讨高血压脑出血、重型颅脑损伤患者围术期早期预防性应用奥美拉唑对胃液pH值的影响以及对应激性溃疡(SU)的疗效。方法 30例急诊高血压脑出血、重型颅脑损伤患者行开颅手术,随机均分为三组,A组于麻醉诱导前予以奥美拉唑40mg,B组和C组在手术后分别予以奥美拉唑40mg、西咪替丁800mg,观察并记录麻醉前(T0)、手术2h(T1)、术毕(T2)及术后ICU第1天(T3)、第2天(T4)、第3天(T5)各时点胃液pH值、胃液红细胞计数及潜血阳性率变化、血浆皮质醇(Cor)、促肾上腺皮质激素(ACTH)浓度。结果 A组胃液pH值在T1～T3时均高于B组和C组(P<0.05),A组血浆ACTH和Cor浓度T1～T3时均低于B组和C组(P<0.05),A组无一例发生SU,B组1例、C组2例发生SU。结论重型颅脑损伤及高血压脑出血患者围术期尽早应用奥美拉唑可以有效的预防SU的发生。Objective To investigate the effect of omeprazole on gastric fluid pH value and acute stress ulcer after hypertensive intracerebral hemorrhage or severe brain injury. Methods Thirty hypertensive intracerebral hemorrhage or severe brain injury patients undergoing craniotomy were randomized divided into three groups A（received 40 mg omeprazole intravenously before induction）, B （40 mg omeprazole at the end of surgery） and C（800 mg Cimetidin at the end of surgery）. Gastric fluid pH value and red blood cell count, occult blood test, plasma corticosteroid （Cot） and adrenocorticotroph （ACTH） were detected before anesthesia（T0）, 2 hr after incision （T1）, at the end of operation（T2 ）, 1, 2. and 3 postoperative day（T3, T4, T5 ）. Results The gastric fluid pH value at T1,T2, and T3 in group A were higher than that of group B and C. （P〈0.05）The plasma concentration of for and ACTH in group A were lower than that of group B and C at T1 ,T2, and T3 （P〈0.05）. Conclusion Prophylactic omeprazole before anesthesia can effectively prevent acute stress ulcer after hypertention intracerebral hemorrhage or severe brain injury.

关 键 词：奥美拉唑 高血压脑出血 重型颅脑损伤 应激性溃疡 

分 类 号：R573.1[医药卫生—消化系统]