早期肠内营养联合质子泵抑制剂对脑卒中应激性溃疡的防治作用研究  

Early Enteral Nutrition with Proton Pump Inhibitor for Prevention and Control of Stress Ulceration in Patients with Acute Stroke

作　　者：赵宏军[1] 张晓苹[2] 王黎萍[1] 吴承龙[1] 马阿火[2] 

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

出　　处：《中国全科医学》2011年第31期3585-3587,共3页Chinese General Practice

基　　金：绍兴市重点科技计划项目(2008A23002)

摘　　要：目的探讨早期肠内营养联合质子泵抑制剂(PPI)对脑卒中应激性溃疡的防治作用。方法将66例急性脑卒中患者随机分为两组,每组33例。A组:静脉滴注奥美拉唑40 mg,2次/d,早期肠内营养;B组:单纯静脉滴注奥美拉唑40 mg,2次/d。并于治疗5 d后清晨监测患者24 h胃内pH值,观察应激性溃疡的发生情况,2周后进行临床疗效评定。结果两组患者24 h胃内平均pH值及中位pH值、夜间胃内平均pH值及中位pH值、24 h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间比较,差异均有统计学意义(P<0.01)。B组的应激性溃疡发生率大于A组,差异有统计学意义(P<0.05);A组的治愈好转率大于B组,差异有统计学意义(P<0.05)。结论早期肠内营养联合应用PPI对脑卒中应激性溃疡的发生有一定的防治作用,早期肠内营养可通过与抑酸药共同调节胃内pH值起作用。Objective To investigate the effect of early enteral nutrition combined with proton pump inhibitor（PPI） to prevent and control the stress ulceration in patients with acute stroke. Methods Sixty-six patients with acute stroke were randomly allocated into two groups,or group A（early enteral nutrition and intravenous injection of Omeprazole 40 mg twice a day） and group B（intravenous injection of Omeprazole 40 mg twice a day）,with 33 in each.Intragastric pH over 24 hours was recorded on the sixth day for each patient.The incidence of stress ulceration was observed,and the clinical effects were evaluated two weeks later. Results The mean intragastric pH and median intragastric pH over 24 hours,nocturnal mean pH and median pH,and the fraction time of mean intragastric pH below 4.0 for the whole day and at night in group A were significantly different with those in group B（P0.05）.The morbidity rate of stress ulceration in group A was lower than that in group B（P0.05）.And the rates of cure and improvement in group A were higher than those in group B（P0.05）. Conclusion The early enteral nutrition combined with PPI has a certain preventive and controlling effects for development of stress ulceration,and the possible mechanism may be adjusting the intragastric pH.

关 键 词：脑卒中 应激性溃疡 肠内营养 质子泵抑制剂 

分 类 号：R743.3[医药卫生—神经病学与精神病学]