两类胃酸分泌抑制剂治疗急性消化性溃疡出血的比较研究  

PPI vs H_2A——which is stronger inhibitor on acute peptic ulcer bleeding?

作　　者：曹义战[1] 刘莉[2] 王伯良[1] 陆将[1] 何保健[1] 仲月霞[1] 宋德根[1] 江华[3] 

机构地区：[1]第四军医大学唐都医院急诊科,陕西西安710038 [2]第四军医大学唐都医院消化内科,陕西西安710038 [3]解放军总医院消化科,北京100853

出　　处：《第四军医大学学报》2001年第9期790-792,共3页Journal of the Fourth Military Medical University

摘　　要：目的　比较抑酸药 H2 受体拮抗剂 (H2 A)与质子泵抑制剂 (PPI)对消化性溃疡出血的疗效 .方法　 130只 SD大鼠随机分成 6组 ,制备急性胃溃疡出血模型 ,以不同 p H值的缓冲液冲洗胃溃疡部位后记录其胃粘膜出血时间 (GMBT) .2 2 4例消化性溃疡急性出血患者 ,随机分 2组 ,2 4h内洛赛克组静滴 40 mg洛赛克 ,法莫替丁组静滴 40 mg法莫替丁 ,动态测定给药前 1h及给药后 2 4h胃内 p H值 . 3回顾性分析2 72例应用洛赛克 (4 0 m g静滴 ,1次· d- 1 )与 2 70例应用法莫替丁 (4 0 mg静滴 ,2次· d- 1 )的消化性溃疡出血患者手术率与死亡率 .结果　当 p H≥ 6 .0时大鼠 GMBT明显缩短 (P<0 .0 5 ) .胃内 p H值监测结果 ,用药后各组 p H>4.0 ,p H>6 .0的时间 ,洛赛克组比法莫替丁组显著延长 (P<0 .0 1) .洛赛克治疗组手术率比法莫替丁治疗组明显减低 (P<0 .0 5 ) ,而死亡率无显著差异 .结论　对急性消化性溃疡出血 ,质子泵抑制剂的抑酸止血效果明显高于 H2AIM To investigate therapeutic effects of H 2 receptor antagonists (H 2A) and proton pump inhibitors (PPI) on peptic uleer bleeding. METHODS Thirty SD rats were randomly divided into 6 groups after gastric mucosal ulcer models were reproduced. The gastric mucosal bleeding time (GMBT) of the 5 groups was measured after the perfusion of ulcer site with pH 3.0, 4.0, 5.0, 6.0 and 7.0 buffer solution, respectively. Twenty four patients with peptic ulcer hemorrhage were randomly divided into 2 groups: during 24 hours, Losec one group received intravenous instillation of 40 mg Losec; Famotidine group 40 mg Famotidine. In each group, 24 hour intragastric pH was dynamically measured. In a retrospective study, the operation rate and mortality of bleeding gastric duodenal ulcer were compared between 272 patients (40 mg Famotidine intraveneously administered once daily) and 270 ones (40 mg Gaster intraveneously administered twice daily). RESULTS GMBT became significantly shorter with buffer solution at pH 6.0 or more than that at pH less than 6.0 ( P <0.05). The time when intragastric pH was over 4.0 or 6.0 in Losec one, was significantly longer than that in Famotidine ones, and the operation rate of bleeding gastrointestinal ulcer patients treated with Losec was statistically lower than that with Famotidine ( P <0.05). CONCLUSION Proton pump inhibitors have stronger anti acid secretory and therapeutic effects on gastrointestinal ulcer bleeding than H receptor antagonists.

关 键 词：H2受体拮抗剂 质子泵抑制剂 消化性溃疡 治疗 

分 类 号：R573.1[医药卫生—消化系统] R975.6[医药卫生—内科学]