不同劑量奧美拉唑防治應激性消化道黏膜損傷的對比研究

潘素華+張麗+何建生+毛可珍??

【摘要】目的對比分析不同劑量奧美拉唑防治應激性消化道黏膜損傷的效果。

方法選擇2014年1月～2016年1月重癥監護室（ICU）收治的180例患者，隨機分為對照組和觀察組（各90例）。兩組患者均給予奧美拉唑以預防和治療應激性消化道黏膜損傷，其中對照組給予常規劑量，觀察組則給予大劑量。治療3 d后，對比兩組患者治療前后胃酸酸堿度變化水平、血液指標變化、胃液潛血試驗、止血效果及不良反應的發生率。

結果治療后兩組患者胃液酸堿度均明顯升高，且觀察組上升更為顯著；觀察組患者抑酸率（以胃酸pH≥6為有效）、血液各項指標、胃液潛血試驗陰性率、治療總有效率明顯高于對照組，差異均有統計學意義（P<0.01）；兩組接受治療后均未出現嚴重的不良反應。

結論大劑量奧美拉唑能有效預防和治療應激性消化道黏膜損傷及其導致的出血癥狀，且無顯著的安全問題，值得臨床應用推廣。

【關鍵詞】奧美拉唑；劑量；應激性消化道黏膜損傷

中圖分類號：R57文獻標識碼：ADOI：10.3969/j.issn.10031383.2017.02.020

【Abstract】ObjectiveTo compare and analyze effects of different doses of omeprazole for prevention and treatment of stressinduced gastrointestinal mucosal injury.

Methods180 cases of patients treated in intensive care unit（ICU） from January，2014 to January，2016 were selected and randomly divided into control group and observation group （90 cases in each group）.Both groups were given omeprazole to prevent and treat stressinduced gastrointestinal mucosal injury，the control group were given conventional dose，and the observation group were given large dose.After 3 days of treatment，changes of gastric acidity，changes in blood parameters，gastric blood occult blood test，hemostasis effects and incidence of adverse reactions between the two groups before and after treatment were compared.

ResultsAfter treatment，the gastric acidity of the two groups significantly increased，and that of the observation group increased more significantly.The acid inhibition rate（with gastric acid pH≥6 as effective），blood parameters，negative rate of gastric blood occult blood test and total effective rate of the observation group were significantly higher than those of the control group，difference was statistically significant （P<0.01）.There was no obvious and serious adverse reactions in the two groups after the treatment.

ConclusionHighdose omeprazole can effectively prevent and treat stressinduced gastrointestinal mucosal injury and the resulting bleeding symptoms without significant safety problems.Thus，it is worthy of clinical application.

【Key words】omeprazole；dose；stressinduced gastrointestinal mucosal injury

應激性消化道黏膜損傷主要是指在嚴重外傷、大手術、顱腦內外傷、大面積燒傷感染或休克等過程中，由于機體強烈的應激反應引起神經、體液以及內分泌功能紊亂，導致交感神經過度興奮，從而促使兒茶酚胺和腎上腺皮質激素大量釋放，使消化道血管明顯收縮致使消化道黏膜原有的保護與損傷機制失衡，最終形成了以消化道潰瘍或黏膜糜爛、壞死為特征的嚴重并發癥[1]。常見于胃黏膜，或可侵及十二指腸，偶有累及食管，病變部位常出現充血、水腫、糜爛和淺表潰瘍，嚴重者可侵及黏膜下，導致損傷部位發生不同程度的出血，亦即上消化道出血[2]。特別是當病變侵蝕大血管時，易引發大出血并導致低血容量性休克，另外還可引起胃穿孔以及全身炎癥反應、甚至出現多器官功能障礙（MODS），臨床死亡率極高且預后極差[3]。臨床實踐已經證明質子泵抑制劑（PPI）可以有效預防和治療應激性消化道潰瘍及出血[4]，故本文對不同劑量的奧美拉唑防治應激性消化道黏膜損傷進行觀察研究，現報告如下。