急性脑梗死患者应激性溃疡夜间酸突破现象研究  

Prevention and Cure of Nocturnal Acid Breakthrough on Stress Ulceration in Patients with Acute Cerebral Infarction

作　　者：赵宏军[1] 孙新芳[1] 张晓苹[2] 马阿火[2] 付文安[2] 

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

出　　处：《中国全科医学》2010年第33期3718-3720,共3页Chinese General Practice

基　　金：绍兴市重点科技计划项目(2008A23002)

摘　　要：目的观察急性脑梗死患者应激性溃疡的夜间酸突破(NAB)现象并探讨防治的方法。方法将入选的80例急性脑梗死患者随机分为4组,每组20例。A组:静脉滴注奥美拉唑40 mg,2次/d;B组:口服(或胃管内灌注)奥美拉唑片40 mg,1次/d;C组:口服(或胃管内灌注)奥美拉唑片20 mg,2次/d;D组:静脉滴注奥美拉唑40 mg,2次/d+静脉滴注西咪替丁600 mg,1次/晚,于第6天早上监测患者24 h胃内pH值。结果 (1)D组患者无NAB发生,A组只有1例发生,C组有3例,B组有5例,D组NAB的发生率显著低于其他各组(P<0.01);(2)4组患者的24 h平均胃内pH值、夜间平均胃内pH值、24 h平均胃内pH<4.0时段占24 h的百分比、夜间平均胃内pH<4.0时段占24 h的百分比比较,差异均有统计学意义(P<0.05)。患者24 h平均胃内pH值、夜间平均胃内pH值D组显著高于B、C组(P<0.01);24 h平均胃内pH<4.0时段占24 h的百分比及夜间平均胃内pH<4.0时段占24 h的百分比D组显著低于B、C组(P<0.01)。24 h平均胃内pH值及24 h平均胃内pH<4.0时段占24 h的百分比D组与A组比较,差异无统计学意义(P>0.05);夜间平均胃内pH值D组高于A组(P<0.05),夜间平均胃内pH<4.0时段占24 h的百分比D组低于A组(P<0.05)。(3)A、B、C、D 4组患者应激性溃疡出血的发生率依次为5%(1/20)、20%(4/20)、15%(3/20)和0,4组应激性溃疡的发生率间差异有统计学意义(P<0.05)。应激性溃疡的发生率B组>C组>A组>D组,差异均有统计学意义(P<0.05)。结论急性脑梗死患者在应激性溃疡的预防中单用奥美拉唑标准剂量多发生NAB,增加奥美拉唑用药次数、剂量及联用西米替丁可以降低NAB的发生,有利于应激性溃疡的预防及患者的预后。Objective To assess the incidence of nocturnal acid breakthrough on stress ulceration in patients with cerebral infarction.Methods Eighty patients with acute cerebral infarction were randomly allocated into four groups.Group A（intravenous injection of omeprazole 40 mg twice a day）;Group B（omeprazole 40 mg Per day orally or through gastric tube）;Group C（omeprazole 20 mg twice a day orally or through gastric tube）;Group D（intravenous injection of omeprazole 40 mg twice a day and plus cimetidine 600 mg at bed time）,intragastric pH over 24 hours was recorded on the sixth day for each patient.Results ①No NAB occurred in group D,1 patient occurred NAB in group A,5 patients in group B,3 patients in group C.The incidence of NAB in group D was significantly fewer than that in group A,B,C（P 0.01） ②The mean intragastric pH,nocturnal mean pH D were significantly higher than B and C group（P 0.01）,and the fraction time of pH below 4.0 for the whole day and at night D were significantly lower than B and C group（P 0.01）.The mean intragastric pH and the fraction time of pH below 4.0 whole day had no satistical difference between group D and A（P 0.05）.Nocturnal mean pH D was high-er than group A（P 0.05）,and the fraction time of pH below 4.0 at night group D was lower than group A（P 0.05）.③ The incidence of stress ulceration bleeding in group D were lower than the other groups（P 0.05）.Conclusion NAB usually occurres in patients with acute cerebral infarction who are treated with omeprazole only.The incidence of NAB and the incidence of stress ulceration bleeding can be decreased by changing doses and methods of omeprazole or combined using of cimetidine.

关 键 词：应激性溃疡 脑梗死 夜间酸突破 

分 类 号：R743.33[医药卫生—神经病学与精神病学]