奥美拉唑治疗老年人急性出血性胃炎的临床观察

目的 观察奥美拉唑治疗老年人包性出血性胃炎的临床疗效。方法 62例急性出血性胃炎的老年患在治疗前插入胃管，用冷生理盐水清洗积血后，留置观察胃内出血情况，然后随机分成两组。奥美拉唑组32例，用奥美拉唑针剂40mg加于5％GS或0.9%NS20ml中静脉注射（静注），5－10分钟注完，每日2次。法莫替丁组30例，用法莫替丁针剂20mg加于5％GS或0.9%NS 20ml中静注，5－10分钟注完，每日2次。结果 奥美拉唑组有效率为94％（30／32）；法莫替丁组有效率为67%(20/30)。两组间比较有非常显性差异（P＜0.01)。结论 奥美拉唑针剂静注是治疗老年人急性出血性胃炎的有效止血药物。     

法莫替丁治疗反流性食管炎多中心临床观察

目的　探讨不同剂量法莫替丁 (商品名 :高舒达 )对反流性食管炎 (RE)的疗效。方法　上海地区 4家医院将 89例经内镜证实的 (洛杉矶分级A级和B级 )RE患者随机分为两组 ,A组 4 6例予以法莫替丁 2 0mg ,每日 2次 ;B组 4 3例予以双倍剂量 ,即 4 0mg ,每日 2次。分别于治疗后 2、4、6、8及 12周观察烧心、反酸、胸痛等症状疗效 ,并于 12周后复查胃镜 ,观察镜下愈合率 ,A组中 9例、B组中 10例患者分别与治疗前及治疗后进行食管 2 4hpH监测。 结果　法莫替丁治疗 2周 ,即可见症状明显改善 ,症状记分较治疗前明显下降 (P <0 .0 1) ,继续用药至第 12周 ,症状记分较第 2周亦显著下降 (P <0 .0 1) ,两组在治疗前及治疗后不同时间症状积分下降值均差异无显著性。治疗 12周时 ,A组症状消失率为 5 2 .17% ,总有效率为 84 .78% ;B组症状消失率为 4 8.83% ,总有效率为 88.37%。两组在症状消失率及有效率方面均差异无显著性 (P >0 .0 5 )。A组食管炎内镜下愈合率为 4 7.83% ,有效率为 82 .6 1% ;B组愈合率为 4 6 .5 1% ,有效率为 86 .0 5 %。两组在内镜下食管炎愈合率及有效率方面均差异无显著性(P >0 .0 5 )。食管 2 4hpH监测显示 ,法莫替丁 4 0mg ,每日 2次患者食管酸暴露次数较治疗前明显减少(P <0 .0 5 )。结论　法莫     

国产格列齐特缓释片治疗2型糖尿病的疗效及安全性

目的评价国产格列齐特缓释片治疗2型糖尿病(T2DM)的疗效和安全性。方法234例T2DM患者随机分为两组:对照组117例,口服格列齐特片,每次80 mg,每日2次;试验组117例,口服格列齐特缓释片,每次60 mg,每日1次。疗程12周。结果225例完成了试验。两组均可有效降低空腹血糖(FBG)、餐后2 h血糖(2 hBG)和糖化血红蛋白(HbA1c),差异无统计学意义。格列齐特缓释片组降低FBG的显效率与总有效率分别为51.26%和93.16%,格列齐特片组的显效率与总有效率分别为44.44%与94.02%。格列齐特缓释片组降低2 hBG的显效率与总有效率分别为29.91%和92.31%,格列齐特片组的显效率与总有效率分别为23.08%与89.74%。两组不良反应发生率均为7.69%。未见严重不良反应及实验室证实的低血糖(血糖≤2.78 mmol/L),个别病例谷丙转氨酶轻度升高。结论国产格列齐特缓释片能有效地降低FBG、2 hBG以及HbA1c水平。患者耐受性好,不良反应轻微。     

沐舒坦不同给药途径治疗AECOPD的疗效观察

目的探讨沐舒坦不同给药途径治疗COPD的临床疗效和安全性。方法将62例慢性阻塞性肺疾病患者随机分成治疗组和对照组,两组分别予常规抗感染、止咳、平喘等相同治疗方法,治疗组给予沐舒坦30mg,每日2次氧驱动雾化吸入;对照组给以沐舒坦30mg,每日2次缓慢静脉注射。用药一疗程后观察治疗效果。结果两组的总有效率(有效率 显效率)无明显差异(P>0.05),分别为93.75%和90.00%,而治疗组显效率明显高于对照组,两组间有显著的差异(P<0.05)。两组均未见明显副作用。结论沐舒坦两种不同给药途径治疗COPD疗效确切,安全性高,沐舒坦雾化治疗操作简单、经济实用,疗效更佳。     

雷贝拉唑四联疗法治疗幽门螺杆菌阳性十二指肠溃疡的疗效观察

目的观察雷贝拉唑治疗幽门螺杆菌(H.pylori)阳性十二指肠溃疡的临床疗效。方法将90例经内镜证实的十二指肠溃疡H.pylori阳性患者随机分成两组:雷贝拉唑组46例,第1周给予雷贝拉唑10mg、阿莫西林1g、克拉霉素0.5g、甲硝唑0.4g,每日2次,以后每日顿服雷贝拉唑10mg;法莫替丁组44例,第1周给予法莫替丁20mg、阿莫西林1g、克拉霉素0.5g、甲硝唑0.4g,每日2次,以后每日口服法莫替丁20mg,每日2次。两组疗程均为4周。停药4周后内镜复查溃疡愈合情况,记录症状改善情况及不良反应。结果治疗后雷贝拉唑组疼痛消失时间1.4±0.7天,短于法莫替丁组的3.1±1.2天(P<0.05);两组治疗后2周末症状消失率分别为84%和86%(P<0.05)。4周末两组的症状消失率、溃疡愈合率、总有效率比较无统计学差异;雷贝拉唑组的H.pylori根除率为98%,高于法莫替丁组的85%(P<0.05);雷贝拉唑组的不良反应发生率为4%,法莫替丁组为9%。结论雷贝拉唑对H.pylori阳性十二指肠溃疡有较高的治愈率和症状改善率,上腹痛消失时间短于法莫替丁组。雷贝拉唑对H.pylori的根除率较法莫替丁高,且不良反应少,服药依从性好。     

国产法莫替丁治疗消化性溃疡多中心双盲及开放的临床研究

我们用青岛制药厂生产的新H_2受体阻滞剂法莫替丁在北京、沈阳、大连、锦州和青岛等七家医院进行了治疗消化性溃疡的多中心临床研究。300例患者服用法莫替丁20mg一天二次共6周,并用甲氰味呱400mg一天一次共6周进行对照(179)。分双盲摸拟和开放两组进行。结果表明法莫替丁在治疗消化溃疡方面疗效与甲氰味呱相似。双盲组中愈合率分别为89.6％与80％(P>0.05),总有效率分别为95.8％与91％(P>0.05)。开放组中法莫替丁愈合率为86.9％,甲氰咪呱组为65％,两组比较P值<0.05。两组的总有效率为96.8％与92.4％(P>0.05)。结果同时表明法莫替丁对十二指肠溃疡和胃溃疡的疗效相似(愈合率为87.5％与86.8％,P>0.05)。未发现法莫替丁组有明显副作用,我们认为,法莫替丁是一种新的、强效的、作用时长的H_2受体阻滞剂,病人易耐受,副作用小,且无抗雄性激素的副作用。     

雷贝拉唑对重症急性胰腺炎患者上消化道出血的预防作用

背景:重症急性胰腺炎(SAP)是一种临床常见的危重疾病,急性胃黏膜病变引起的上消化道出血是SAP较为常见的并发症。目的:观察雷贝拉唑对SAP患者上消化道出血的预防作用。方法:30例SAP患者随机分为两组,分别予雷贝拉唑20mg每日1次口服(n=20)和法莫替丁40mg每日2次静脉滴注(n=10),疗程1周。于用药前24h至用药后72h连续监测上消化道出血的发生情况和胃内pH的变化。结果:雷贝拉唑组患者无呕血和黑粪出现,法莫替丁组有1例患者出现黑粪,发生率为10%。用药后,两组患者的胃内pH和pH>3、pH>4、pH>5的时间百分比均显著升高,雷贝拉唑组升高较法莫替丁组显著(P<0.05)。两组患者均未发生明显不良反应。结论:雷贝拉唑和法莫替丁均能升高SAP患者的胃内pH,对上消化道出血有预防作用,且无明显不良反应。雷贝拉唑维持胃内较高pH的时间较法莫替丁更长。     

非洛地平治疗高血压180例疗效分析

目的观察非洛地平(联环尔定)对Ⅰ级、Ⅱ级、Ⅲ级高血压病病人的降压疗效及不良反应。方法将高血压病病人180例分为Ⅰ级、Ⅱ级、Ⅲ级高血压组,每组60例,每组随机分为A、B两个亚组,每个亚组各30例,两个亚组间病人的年龄、性别相当。Ⅰ级高血压A(ⅠA)组非洛地平2.5mg,每日2次口服;B(ⅠB)组非洛地平5.0mg,每日2次口服。Ⅱ级高血压A(ⅡA)组非洛地平5.0mg,每日2次口服;B(ⅡB)组非洛地平7.5mg,每日2次口服。Ⅲ级高血压A(ⅢA)组非洛地平7.5mg,每日2次口服;B(ⅢB)组非洛地平10.0mg日2次口服。疗程2个月。结果ⅠA组总有效率93.3%,ⅠB组总有效率100.0%,ⅡA组总有效率90.0%,ⅡB组总有效率96.7%,ⅢA组显总有效率83.3%,ⅢB组总有效率90.0%。非洛地平的不良反应轻微,主要有下肢及踝部水肿、头痛、心悸、齿龈轻度增生等。结论非洛地平是治疗高血压尤其是Ⅰ级、Ⅱ级高血压病的理想降压药。在允许剂量内,剂量增加,降压疗效随之增加。不良反应少而轻微,病人多可耐受。     

补阳还五汤加味治疗气虚血瘀型冠心病

目的观察补阳还五汤加味治疗气虚血瘀型冠心病的疗效。方法将60例气虚血瘀型冠心病患者随机分为治疗组和对照组,各30例。两组均口服阿司匹林0.1g,美托洛尔(倍他乐克)25mg,每日3次;依姆多30mg,每日1次,辛伐他汀(舒降之)20mg,每日1次。治疗组在此基础上予补阳还五汤加味每日一剂早晚分服,疗程15d,连续服药2个疗程后统计疗效。结果治疗组总有效率90%,对照组总有效率70%,治疗组疗效明显优于对照组(P<0.05)。结论补阳还五汤加味治疗气虚血瘀型冠心病疗效确切。     

复方儿茶胶囊治疗消化性溃疡疗效观察

目的观察复方儿茶胶囊对消化性溃疡的近期和远期疗效。方法经胃镜确诊的消化性溃疡261例,随机分为西米替丁组87例(西米替丁0.2g,每天3次口服,睡前加服0.4g),丽珠得乐组87例(丽珠得乐110mg,每天4次口服),复方儿茶胶囊组87例(复方儿茶胶囊0.515g,每天3次口服)。治疗前、治疗8周后及1年后距幽门5cm以内取胃组织,用快速尿素酶法测定幽门螺杆菌(HP)。结果西米替丁组、丽珠得乐组、复方儿茶胶囊组总有效率分别为86.2％,88.5％．97.7％,复方儿茶胶囊组与前两组相比P＜0.05。溃疡愈合率分别为70.1％．75.9％,90.8％．复方儿茶胶囊组与前两组相比P＜0.05。HP根除率分别为1.9％,57.4％,76.8％,复方儿茶胶囊组与丽珠得乐组相比P＜0.05,与西米替丁组相比P＜0.01。结论复方儿茶胶囊组溃疡近期疗效及HP根除率均高于西米替丁组和丽珠得乐组,复发率均低于西米替丁组和丽珠得乐组。     

Comparison of the effects of intravenous infusion of omeprazole and H2‐receptor antagonists on intragastric pH in bleeding duodenal ulcer patients

OBJECTIVE : To evaluate the effects of intravenous infusion of omeprazole and H₂‐receptor antagonists on 24‐h intragastric pH levels in patients with bleeding duodenal ulcers. METHODS : Fifty patients with active bleeding duodenal ulcers were randomly assigned to receive one of four treatment regimens: 40 mg omeprazole by intravenous infusion every 12 h, 40 mg famotidine intravenously every 12 h, 50 mg ranitidine intravenously every 6 h, 200 mg cimetidine intravenously every 6 h. Intragastric pH values were monitored in each subject at the baseline level and continuously for 24 h after treatment. RESULTS : Only the omeprazole group produced mean and median intragastric pH values of above 6. The famotidine group had mean and median intragastric pH values above 4. In the other two groups, pH values were both below 4. The mean percentages of time that intragastric pH levels were < 4, < 5 and < 6 over the 24 h period in each of the treatment groups were found to increase in the following order (smallest percentage to largest percentage): omeprazole, famotidine, ranitidine and cimetidine. CONCLUSIONS : The effect of intravenous use of omeprazole in active duodenal ulcer bleeding is superior to that of H₂‐receptor antagonists and the increase in intragastric pH is maintained for a longer period.     

幽门螺杆菌感染和长期服用阿司匹林与上消化道出血关系研究

目的:探讨幽门螺杆菌(Hp)感染患者长期服用阿司匹林与上消化道出血的关系。方法:选取门诊每日服用100mg阿司匹林的患者,进行胃镜检查并检测Hp。根据Hp检测结果将3809例入选对象分为Hp阳性组和Hp阴性组,随访2年,观察上消化道出血情况;Hp阳性伴上消化道出血患者抗Hp治疗根除Hp后分组,分别给予法莫替丁40mg睡前顿服(干预组),或不加干预者作为对照组,2组均继续服用阿司匹林,随访2年,观察其再出血情况。结果:60岁以上老年患者服用小剂量阿司匹林上消化道出血率明显高于60岁以下患者(P<0.05);Hp阳性组2802例患者中上消化道出血146例(5.21%),Hp阴性组共1007例患者,上消化道出血为30例(2.98%),2组相比差异有统计学意义(P<0.05);144例患者根除Hp法莫替丁干预组72例,上消化道再出血2例(2.78%),对照组72例,上消化道再出血8例(11.1%),2组相比差异有统计学意义(P<0.05)。结论:60岁以上老年患者服用小剂量阿司匹林增加上消化道出血风险;Hp感染并长期服用小剂量阿司匹林可增加患者上消化道出血风险;法莫替丁干预能有效降低长期服用小剂量阿司匹林患者上消化道再出血风险。     

Prevention of stress-induced upper gastrointestinal bleeding by cimetidine in patients on assisted ventilation

A double-blind controlled trial was conducted in which the efficacy of cimetidine in a dosage of 20 mg/kg/24 h in preventing upper gastrointestinal hemorrhage was tested in 34 critically ill patients on assisted ventilation. In 28 patients, 14 on cimetidine and 14 on placebo, gastric pH measurements and blood loss measured by 51Cr-labelled erythrocytes could be analyzed. Although cimetidine produced a markedly lower number of days with a gastric pH below 3.5 (17.4% vs. 72.2%) 5 patients on cimetidine bled as against 1 on placebo. These results do not suggest that cimetidine was effective in preventing stress-induced upper gastrointestinal bleeding.     

泮托拉唑治疗急性上消化道出血疗效观察

目的　观察泮托拉唑治疗上消化道出血的效果。方法　 98例急性上消化道出血患者经内镜诊断急性糜烂出血性胃炎 3 4例 ,十二指肠球部溃疡伴出血 5 2例 ,胃溃疡伴出血 12例。分三组治疗 ,A组静滴泮托拉唑 40mg 2次 /d ,B组静滴法莫替丁2 0mg 2次 /d ,C组静滴止血芳酸 0 3 2次 /d。结果　A组有效率 97 2 2 % ,B组有效率 78 79% ,C组有效率 5 5 17%。A组与B、C两组比较P <0 0 1。结论　泮托拉唑治疗急性上消化道出血疗效显著     

Randomized Comparison of Gastric pH Control with Intermittent and Continuous Intravenous Infusion of Famotidine in ICU Patients

Objective : To compare gastric pH control using intravenous famotidine as a primed, continuous infusion versus intermittent infusion. Methods : In a prospective, double-blind study, 40 ICU patients at risk for stress ulceration were randomly assigned to receive either famotidine 20 mg intravenous bolus followed by 1.67 mg/h infusion or famotidine 20 mg intravenously every 12 h. Intraluminal gastric pH was recorded at baseline and every 4 h using a glass electrode. Clinical outcome indicators were also monitored. Subjects were studied for a minimum of 24 h and a maximum of 6 days. Continuous variables were analyzed by ANOVA and nominal variables by Fisher's exact test (α= 0.05). Results : Nineteen patients were randomized to the continuous infusion group, and 21 were randomized to the intermittent group. Using gastric pH greater than 4.0 as an endpoint, the continuous group exhibited better pH control, both in terms of percentage of total measurements (83% versus 63%, p < 0.001) and time spent above pH 4.0 (91% versus 76%, p < 0.01). Similar results were found at pH greater than 5.0 (78% versus 56% for all measurements for the continuous and bolus groups, respectively ( p < 0.001), and 88% versus 72% for the time spent above pH 5.0 ( p < 0.01). Clinical outcomes, including evidence for gastrointestinal bleeding and hospital mortality, did not differ significantly between groups. Conclusion : Famotidine infusion at 1.67 mg/h, when preceded by a bolus dose of 20 mg, provides a greater and more sustained increase in gastric pH than intermittent administration of famotidine 20 mg every 12 h.     

洛赛克治疗老年急性上消化道出血80例疗效观察

本文比较了洛赛克（ｌｏｓｅｃ）与信法丁（ｆａｍｏｔｉｎｅ）治疗８０例老年人急性上消化道出血的止血疗效。结果洛赛克总有效率为９６．７％，较信法丁８３．３％显著（Ｐ＜０．０５）。在应用中，未发现其对各重要器官的功能和合并症造成影响，实验室检查无异常发现，副作用轻微。提示了对患有４种以上合并症，出血量达＞１０００亳升，病因为急性胃粘膜病、胃癌的老年人急性上消化道出血，洛赛克是一种可供优先选择的药物，疗程一般为５天左右。     

Controlled trial of medical therapy for active upper gastrointestinal bleeding and prevention of rebleeding

This multicentered, placebo-controlled trial evaluated the efficacy of medical therapy to stop bleeding in 285 patients with active upper gastrointestinal bleeding (bleeding phase) and 194 patients who had ceased gastrointestinal bleeding and in whom therapy was instituted to prevent rebleeding during the same hospitalization (prevention phase). Patients in the bleeding phase were given cimetidine (300 mg every six hours) or intravenous placebo. There was no significant overall difference between intravenous cimetidine (71 percent) and placebo (77 percent) in stopping acute upper gastrointestinal bleeding. There was also no significant difference noted between intravenous cimetidine and placebo when specific bleeding lesions were evaluated. Once gastrointestinal bleeding had stopped, recurrence of bleeding while receiving prevention therapy (cimetidine tablets 300 mg one three times a day and at bedtime, or Mylanta II liquid 30 ml every hour, or cimetidine plus hourly antacids, or placebo) was evaluated in 194 of the patients in the bleeding phase. Twenty-four percent (12 of 51 patients) rebled while receiving cimetidine, 13 percent (five of 39 patients) rebled while receiving hourly antacids, 11 percent (six of 54 patients) rebled while receiving cimetidine plus hourly antacids, and 26 percent (13 of 50 patients) rebled while receiving placebo. None of these prevention regimens reached statistical significance (p = 0.13). Evaluation of specific bleeding lesions within this group also failed to show any significant value of prevention therapy. In conclusion: (1) intravenous cimetidine offers no advantage over placebo in stopping active upper gastrointestinal bleeding; (2) the occurrence of rebleeding during the same hospitalization does not appear to be significantly affected by any of the medical regimens used for prevention. These findings would suggest that the cessation of active bleeding and the prevention of recurrent upper gastrointestinal bleeding during a single hospitalization appear to be unaffected by therapy directed at acid neutralization or reduction.     

埃索美拉唑、法莫替丁和铝碳酸镁预防急性冠脉综合征患者上消化道损伤的效果

目的观察埃索美拉唑、法莫替丁和铝碳酸镁预防急性冠脉综合征（ACS）患者上消化道损伤的效果。方法符合人选条件的182例患者,在急性冠脉综合征治疗基础上,随机分为4组：A组,对照组;B组,埃索美拉唑20mg,bid;C组,法莫替丁20mg,bid;D组,铝碳酸镁1000mg,tid。治疗期间通过观察呕血、黑便、上腹不适（或疼痛）和烧心症状,检测粪便隐血试验,胃镜检查,确定消化道损伤发生;同时观察心血管不良事件发生。患者出院后门诊随访3个月。结果A组48例,消化道损伤发生率为31．25％（15／48）;B组43例,消化道损伤发生率6．98％（3／43）;C组46例,消化道损伤发生率10．87％（5／46）;D组45例,消化道损伤发生率13．33％（6／45）。四组消化道损伤发生率经统计学分析,B组与A组比较差异有统计学意义（P=0．004）,C组、D组与A组比较差异无统计学意义（P〉0．05）。A组中2例（4．17％）因消化道出血停用阿司匹林,发生支架内血栓事件。结论埃索美拉唑、法莫替丁和铝碳酸镁对ACS患者消化道损伤的发生有预防作用,但以埃索美拉唑效果最好。     

Comparison of adjuvant therapies by an H2-receptor antagonist and a proton pump inhibitor after endoscopic treatment in hemostatic management of bleeding gastroduodenal ulcers

Aim: Upper gastrointestinal bleeding is often associated with a higher risk of serious blood loss. Both H2‐receptor antagonists and proton pump inhibitors are commonly given intravenously for endoscopic hemostatic therapies. We compared the effects of a H2‐receptor antagonist (famotidine) and a proton pump inhibitor (omeprazole) injected during the early phase (the first 3 days) on cessation of bleeding and prevention of its recurrence in patients who underwent endoscopic therapy for gastroduodenal ulcer bleeding. Methods: Consecutive patients who were hospitalized at our clinic with bleeding gastroduodenal ulcers and underwent endoscopic therapy were randomly assigned to receive injections of famotidine, omeprazole, or both. Injection of acid suppressants was switched on the fourth day to the oral administration of omeprazole continued for 8 weeks. Results: Over a 25‐month period, 116 patients were enrolled. The overall success rate for endoscopic hemostasis was 115/116 (99.1%). The success rate of hemostasis and prevention of recurrent ulcer bleeding by type of acid suppressant following endoscopic hemostasis was 39/40 (97.5%) for Group 1 (3‐day omeprazole administration), 35/37 (94.6%) for Group 2 (3‐day famotidine administration), and 38/39 (97.4%) for Group 3 (1‐day famotidine and then 2‐day omeprazole administration), yielding an overall rate of 112/116 (96.6%). No significant difference in the hemostatic effect was observed among the groups. There were also no differences in the duration of hospital days and the number of fasting days between the three groups. Conclusion: Famotidine and omeprazole injected during the early phase of a bleeding ulcer may have similar effects to an adjuvant therapy for preventing rebleeding from endoscopically treated upper gastrointestinal bleeding in Japanese patients.