不同劑量奧美拉唑防治應(yīng)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(yīng)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(jiān)護(hù)室（ICU）收治的180例患者，隨機(jī)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(yù)防和治療應(yīng)激性消化道黏膜損傷，其中對照組給予常規(guī)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(biāo)變化、胃液潛血試驗(yàn)、止血效果及不良反應(yīng)的發(fā)生率。

結(jié)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(xiàng)指標(biāo)、胃液潛血試驗(yàn)陰性率、治療總有效率明顯高于對照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.01）；兩組接受治療后均未出現(xiàn)嚴(yán)重的不良反應(yīng)。

結(jié)論大劑量奧美拉唑能有效預(yù)防和治療應(yīng)激性消化道黏膜損傷及其導(dǎo)致的出血癥狀，且無顯著的安全問題，值得臨床應(yīng)用推廣。

【關(guān)鍵詞】奧美拉唑；劑量；應(yīng)激性消化道黏膜損傷

中圖分類號：R57文獻(xiàn)標(biāo)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(yīng)激性消化道黏膜損傷主要是指在嚴(yán)重外傷、大手術(shù)、顱腦內(nèi)外傷、大面積燒傷感染或休克等過程中，由于機(jī)體強(qiáng)烈的應(yīng)激反應(yīng)引起神經(jīng)、體液以及內(nèi)分泌功能紊亂，導(dǎo)致交感神經(jīng)過度興奮，從而促使兒茶酚胺和腎上腺皮質(zhì)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(hù)與損傷機(jī)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(yán)重并發(fā)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(xiàn)充血、水腫、糜爛和淺表潰瘍，嚴(yán)重者可侵及黏膜下，導(dǎo)致?lián)p傷部位發(fā)生不同程度的出血，亦即上消化道出血[2]。特別是當(dāng)病變侵蝕大血管時，易引發(fā)大出血并導(dǎo)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(yīng)、甚至出現(xiàn)多器官功能障礙（MODS），臨床死亡率極高且預(yù)后極差[3]。臨床實(shí)踐已經(jīng)證明質(zhì)子泵抑制劑（PPI）可以有效預(yù)防和治療應(yīng)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(yīng)激性消化道黏膜損傷進(jìn)行觀察研究，現(xiàn)報告如下。