不同劑量艾司奧美拉唑治療急性非靜脈曲張性上消化道出血的隨機對照試驗

程進偉　余志金　陳惠新

【摘要】 目的：不同劑量艾司奧美拉唑治療急性非靜脈曲張性上消化道出血的臨床效果和安全性。方法：選取2017年4-10月本院新診斷急性非靜脈曲張性上消化道出血患者174例，按隨機數字表法分為觀察組和對照組，每組87例。觀察組給予80 mg艾司奧美拉唑治療，對照組給予40 mg艾司奧美拉唑治療。比較兩組不同時間點止血率、胃pH值及不良反應發生率。結果：觀察組給藥后4、6、12 h止血率均高于對照組，差異均有統計學意義（P<0.05）;兩組給藥后18、24、48 h止血率比較，差異均無統計學意義（P>0.05）。觀察組給藥后4、6、12 h胃pH值均高于對照組，差異均有統計學意義（P<0.05）;兩組給藥后18、24、48 h胃pH值比較，差異均無統計學意義（P>0.05）。兩組不良反應發生率比較，差異無統計學意義（P>0.05）。結論：對于急性非靜脈曲張性上消化道出血，80 mg與40 mg艾司奧美拉唑靜脈滴注相比起效更快，且不增加不良反應。

【關鍵詞】 急性非靜脈曲張性上消化道出血; 艾司奧美拉唑; 劑量; 療效; 安全性

【Abstract】 Objective：To explore the curative effect and safety of different doses of Esomeprazole in treatment of acute nonvaricealupper gastroint estinal bleeing.Method：174 patients with acute nonvaricealupper gastroint estinal bleeing were selected from April to October 2017 in our hospitals，and they were divided into the observation group and the control group according to the random number table method，87 cases in each group.The observation group was treated with 80 mg Esomeprazole，the control group was treated with 40 mg Esomeprazole.The hemostatic rate，intragastric pH of two groups at different time points were compared，and the incidence of adverse reactions of two groups was compared.Result：4，6，12 h after injection，the hemostatic rate of the observation group were higher than those in the control group，the differences were statistically significant（P<0.05）.18，24，48 h after injection，the hemostatic rate between two groups were compared，the differences were not statistically significant（P>0.05）.4，6，12 h after injection，the intragastric pH of the observation group were higher than those in the control group，the differences were statistically significant（P<0.05）.18，24，48 h after injection，the intragastric pH between two groups was compared，the differences were not statistically significant（P>0.05）.The inciclence of adverse reactions was compared between two groups，the difference was not statistically significant（P>0.05）.Conclusion：For acute nonvaricealupper gastroint estinal bleeding，80 mg of Esomeprazole is more effective than 40 mg of Esomeprazole，and does not increase adverse reactions.

【Key words】 Acute nonvaricealupper gastroint estinal bleeding; Esomeprazole; Dose; Curative effect; Safety

First-authors address：The Central Peoples Hospital of Huizhou City，Huizhou 516001，China

doi：10.3969/j.issn.1674-4985.2019.12.033

急性非靜脈曲張性上消化道出血是指屈氏韌帶以上消化道的非靜脈曲張性疾患引起的出血，是臨床最常見的危重急癥之一[1-2]。其中胃部出血及十二指腸出血在整個急性非靜脈曲張性上消化道出血中所占比例最高，主要癥狀表現為嘔血、黑便，失血情況嚴重者可伴見急性周圍循環障礙及多器官功能障礙綜合征[3-6]。研究表明，靜脈注射艾司奧美拉唑能為急性非靜脈曲張性上消化道出血的止血機制發揮創造條件[7-9]。然而，靜脈注射艾司奧美拉唑能急性非靜脈曲張性上消化道出血的最佳使用劑量仍然存在爭議[10]。為此，本院開展本研究，旨在通過循證醫學的研究方法探討不同劑量艾司奧美拉唑治療急性非靜脈曲張性上消化道出血的臨床療效和安全性，為臨床應用艾司奧美拉唑治療急性非靜脈曲張性上消化道出血提供科學依據。現報道如下。