大劑量奧美拉唑治療消化性潰瘍出血的有效性與安全性

劉小娟

摘要：目的 ?研究無痛內鏡下止血聯合大劑量奧美拉唑治療消化性潰瘍的臨床療效和安全性。方法 ?選取2019年1月～2020年1月在我院診治的86例消化性潰瘍出血患者為研究對象，采用隨機數字表法分為對照組和觀察組，各43例。兩組均采用無痛內鏡下止血治療，對照組聯合常規劑量奧美拉唑治療，觀察組聯合大劑量奧美拉唑治療，比較兩組不同時間段（8、12、24 h）止血率、止血時間、輸血量、住院時間、再出血發生率、空腹胃液的pH值以及不良反應發生情況。結果 ?觀察組8、12、24 h止血率均高于對照組，差異有統計學意義（P<0.05）;觀察組止血時間、輸血量、住院時間、再出血發生率均小于對照組，差異有統計學意義（P<0.05）;治療8、12、24 h后，兩組空腹胃液PH值均高于治療前，且觀察組高，且觀察組高于對照組，差異有統計學意義（P<0.05）;觀察組不良反應發生率為6.97%，與對照組的9.30%比較，差異無統計學意義（P>0.05）。結論 ?在無痛內鏡下止血聯合大劑量奧美拉唑治療消化性潰瘍出血效果確切，可提高止血有效率、縮短止血時間和住院時間，減少輸血量，降低再出血率和空腹胃液pH值，且不會增加不良反應，應用安全性良好。

關鍵詞：無痛內鏡;大劑量;奧美拉唑;消化性潰瘍出血;安全性

中圖分類號：R573.1 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2020.17.041

文章編號：1006-1959（2020）17-0143-03

Abstract：Objective ?To study the clinical efficacy and safety of painless endoscopic hemostasis combined with high-dose omeprazole in the treatment of peptic ulcer.Methods ?A total of 86 patients with peptic ulcer hemorrhage who were diagnosed and treated in our hospital from January 2019 to January 2020 were selected as the research objects. They were divided into control group and observation group by random number table method， with 43 cases in each group. Both groups were treated with painless endoscopic hemostasis， the control group was combined with conventional dose omeprazole treatment， and the observation group was combined with high-dose omeprazole treatment. The two groups were compared with different time periods （8， 12， 24 h） hemostasis rate， hemostasis time， blood transfusion， length of hospital stay， incidence of rebleeding， pH value of fasting gastric juice and occurrence of adverse reactions.Results ?The rate of hemostasis at 8， 12， and 24 h in the observation group was higher than that in the control group，the difference was statistically significant （P<0.05）; the observation groups hemostasis time， blood transfusion volume， hospital stay， and incidence of rebleeding were all lower than those in the control group，the difference was statistically significant（P<0.05）; after 8， 12， and 24 h of treatment， the PH value of fasting gastric juice in the two groups was higher than before treatment， and the observation group was higher， and the observation group was higher than the control group， the difference was statistically significant （P<0.05）; the incidence of adverse reactions in the observation group was 6.97%， compared with 9.30% in the control group， the difference was not statistically significant （P>0.05）.Conclusion ?The effect of hemostasis combined with high-dose omeprazole under painless endoscopy in the treatment of peptic ulcer bleeding could improve the effective rate of hemostasis， shorten the time of hemostasis and hospital stay， reduce the amount of blood transfusion， reduce the rate of rebleeding and the pH of fasting gastric juice，and it will not increase adverse reactions， and the application safety is good.

Key words：Painless endoscopy;High-dose;Omeprazole;Peptic ulcer bleeding;Safety

消化性潰瘍（peptic ulcer）出血是臨床常見急癥，由于自身胃液分泌過度，對胃黏膜造成損傷形成潰瘍，同時潰瘍侵蝕周圍血管造成出血發生[1]。當前，臨床通常采用內鏡下止血聯合質子泵抑制劑進行治療，無痛內鏡介入止血，可直接觀察出血病灶，并對出血點直接進行處理，可有效止血[2]。質子泵抑制劑在內徑止血基礎上應用，可減少內鏡止血后再出血，但是目前臨床關于給藥最佳劑量存在爭議[3]。奧美拉唑對潰瘍出血具有一定緩解作用，但是臨床已有研究指出，不同劑量其臨床療效存在差異[4]，如何科學合理選擇其劑量一直是臨床迫切關注的問題?！?br>