奥美拉唑联合克拉霉素、阿莫西林治疗老年消化性溃疡35例

<正>近年来,老年消化性溃疡发病率逐年增高,多采取抑酸、保护胃黏膜、抗幽门螺杆菌(Hp)等方法治疗〔1〕,但耐药性、毒副反应等问题较多;尤其是老年患者各器官、系统功能减退,溃疡愈合时间长,易反复,并发症多,死亡率高〔2〕。据文献报道〔3〕,老年消化性溃疡大出血占20%⁴0%,穿孔占16%40%,穿孔占16%¹8%,病死率高达10%。本文观察我院近期采用奥美拉唑联合克拉霉素、阿莫西林治疗老年消化性溃疡患者的效果。     

奥美拉唑、呋喃唑酮、阿莫西林三联疗法治疗幽门螺杆菌相关性消化性溃疡的疗效观察

目的观察奥美拉唑、呋喃唑酮、阿莫西林三联疗法对消化性溃疡（PU）的治疗效果及幽门螺杆菌（Hp）的根除效果。方法对64例幽门螺杆菌阳性的消化性溃疡患者，随机分为治疗组及对照组。治疗组33例，给予奥美拉唑20mg，每日1次，呋喃唑酮100mg，每日2次；阿莫西林1000mg，每日2次，饭前服用1周；对照组31例，给予奥美拉唑20mg，每日2次，克拉霉素500mg，每日2次，阿莫西林1000mg，每日2次，饭前服用1周；停药4周后复查胃镜。结果治疗组与对照组Hp根除率分别为90．9％、93．5％，差异无显著性（P〉0．05）；溃疡愈合率分别为93．9％、96．8％，差异无显著性（P〉0．05）。结论奥美拉唑、呋喃唑酮、阿莫西林三联疗法具有疗程短、疗效高，依从性好、费用低，值得基层医院推广应用。     

奥美拉唑果胶铋阿莫西林治疗肝源性溃疡的临床观察

目的评价奥美拉唑,果胶铋,阿莫西林对肝源性溃疡(HU)的疗效.方法对300例肝硬变患者全部经内镜检出溃疡60例,溃疡检出率为20%.全部溃疡予每日晨及晚上十时分别口服奥美拉唑20mg,每日口服果胶铋100mg3次,4wk～6wk,阿莫西林1000mg,2次/d,2wk.观察其临床症状改善情况及内镜下溃疡愈合情况,并与同期消化性溃疡(PU)疗效对比分析.结果4wk溃疡愈合率HU组十二指肠溃疡(DU)为80%(32/40),胃溃疡(GU)为63%(10/16).PU组中DU和GU均为100%(40/40).6wkHU中DU为92.5%(37/40),GU为87.5%(14/16).4wk时两组比较有显著性差异(P<0.05).结论奥美拉唑,果胶铋,阿莫西林联用是治疗肝源性溃疡的一种有效方法.     

雷贝拉唑和克拉霉素联合阿莫西林疗法治疗胃溃疡的疗效观察

选取我院2015年1月~2016年1月收治的50例胃溃疡患者,按照患者住院的先后顺序,分成观察组和对照组,各25例。观察组通过雷贝拉唑、克拉霉素、阿莫西林联合治疗,对照组给予奥美拉唑、克拉霉素、阿莫西林联合治疗,对比两组临床疗效、不良反应情况。结果观察组和对照组的治疗总有效率、不良反应发生率分别为:96%、8%;72%、36%;组间比较,差异显著,P<0.05。结论胃溃疡通过雷贝拉唑、克拉霉素、阿莫西林联合治疗,临床效果较佳,且能有效的控制不良反应发生率,值得临床深入推广。     

奥美拉唑在肝源性溃疡的疗效分析

奥美拉唑在肝源性溃疡的疗效报道相对较少。我们总结了我院用奥美拉唑治疗肝源性溃疡 4 8例 ,并与同期消化性溃疡的疗效进行对比 ,报道如下。资料与方法病例选择　 1997年 10月至 2 0 0 2年 4月在我院住院及门诊肝硬化患者进行胃镜检查 2 35例 ,检出溃疡 5 1例 ,占 2 1.7%。按规定疗程完成并复查胃镜者 4 8例 (男 39,女 9) ,平均年龄 4 6 .9(2 9～ 74 )岁。肝硬化除典型临床表现外 ,均经肝功能检查、B超、CT诊断 ,11例为手术病理证实。其中肝炎后肝硬化 39例 ,酒精性肝硬化 7例 ,胆汁性肝硬化 2例。肝功能ChildA级 11例 ,B级 2 9例 ,C级 …     

奥美拉唑、替硝唑、克拉霉素短程三联疗法根除老年人幽门螺杆菌的疗效观察

目的观察奥美拉唑、替硝唑，克拉霉素短程三联疗法对我国老年人幽门螺杆菌LHelicobactcr pylori，Hp)感染的根除效果及其不良反应，方法将91例伴有Hp感染的消化性溃疡或糜烂性胃窦炎老年病人，随机分为A．B两组，A组46例，B纽45例，各有2例失访，A组以奥美拉唑20mg替硝唑500mg、克拉霉素250mg，每天2次疗程7天(简称OTC250方案）：B组治疗同A组、只是将克拉霉素改为500mg（简称OTC500方案)，活动期溃疡病病例，继服奥美拉唑20mg／天，3周。疗程结束1月后复查胃镜及胃窦、胃体粘膜Hp检查。结果Hp根除率A组909％140／44)，B组88.4％(38／43)；活动期溃疡愈合率A组100％(12/12)，B组93.3％（14／15)：糜烂性胃窦炎愈合率：A组79.3％(23／29)，B组80.8％(21／26)不良反应发生率：A组13.6％(6／44)，B组23.3％(10／43)：P均>0.05。主要不良反应为口腔金属味、纳差、乏力，恶心等、但均能继续服药，结论OTC250及OTC500两种短程三联方案．对老年人Hp感染舶根踪均有良好疗效，且耐受性良好，可怍为Hp根除的第一线方案。而OTC250方案还有费用低、不良反应少等优点更适合我国国情、尤其适合于老年人根除Hp.     

三联疗法治疗幽门螺杆菌相关性消化性溃疡疗效观察

目的：研究不含甲硝唑的短程低剂量质子泵抑制剂（ＰＰＩ）三联疗法对幽门螺杆菌（ＨＰ）根除消化性溃疡愈合的疗效。方法：采用随机双盲对照研究。将４７ 例ＨＰ阳性的消化性溃疡患者随机分为２ 组,即Ａ组（低剂量三联）采用达克普隆３０ ｍ ｇ １次／ｄ 加克拉霉素２５０ ｍ ｇ ２ 次／ｄ 加阿莫西林５００ ｍ ｇ ２ 次／ｄ,连服１０ ｄ;Ｂ组（安慰剂）采用胃舒平３片,２ 次／ｄ,连用４ 周,双盲双模拟用药。疗程结束后４ 周复查胃镜。结果：Ａ组ＨＰ根治率和溃疡愈合率分别为９３．３％ 和８６．７％ ,明显高于Ｂ组的０ 和２３．５％ （均Ｐ＜ ０．０５）。前者对症状缓解作用好、速度快,无明显副作用,患者依从性好。结论：短程低剂量ＰＰＩ三联疗法是治疗ＨＰ相关性消化性溃疡较为理想的治疗方案,尤其对甲硝唑耐药者更值得试用     

奥美拉唑联合心得安治疗肝源性溃疡22例

肝硬化患者合并消化性溃疡的发生率为5.4%～23.8%,是正常人群的2～3倍,临床又称之为肝源性溃疡(hepatogeniculcer,HU)[1],由于其症状不典型以至于常被延误治疗.2000年10月至2003年1月,我们对肝硬化合并消化性溃疡43例患者作了临床观察治疗,现报告如下.     

奥美拉唑、阿莫西林、甲硝唑三联治疗消化性溃疡的临床疗效分析

目的探讨与分析奥美拉唑、阿莫西林、甲硝唑三联治疗消化性溃疡的临床疗效。方法将入住我院的消化性溃疡患者随机分为两组,对照组患者采用雷尼替丁,同时辅以阿莫西林和甲硝唑进行治疗,观察组患者则采取奥美拉唑、阿莫西林、甲硝唑三联治疗。两组疗程均为2周。结果观察组治疗总有效率达98．O％,对照组治疗总有效率仅为75．0％,观察组治疗效果明显优于对照组,差异有统计学意sC（P〈0．05）。结论奥美拉唑、阿莫西林、甲硝唑三联治疗消化性溃疡的临床疗效显著,值得临床推广应用。     

奥美拉唑,替硝唑,克拉霉素短程三联疗法根除老年人幽门螺…

目的 观察奥美拉唑，替硝唑，克拉霉素短程三联疗法对老年人幽门螺杆菌（Ｈｐ）感染的根除效果及其副反应。方法 将８７例伴有Ｈｐ感染的消化性溃疡或糜烂胃窦炎老年患者随机分为两组，Ａ组为４４例，给予奥美拉唑２０ｍｇ，替硝唑５００ｍｇ及克拉霉素２５０ｍｇ，每天２次口服，疗程７天（方案Ａ），Ｂ组４３例，治疗同Ａ组，只是将克拉霉素改为５００ｍｇ（方案Ｂ），活动期溃疡病患者继服奥拉唑２０ｍｇ／ｄ，３周，疗程结束１     

Transfer of Clarithromycin to Gastric Juice is Enhanced by Omeprazole in Helicobacter pylori -Infected Individuals

Background: The effects of proton-pump inhibitors and Helicobacter pylori infection on the distribution of drugs employed for the eradication of H. pylori are poorly understood. The aim of this study was to investigate the effects of a 7-day oral administration of 20 mg omeprazole on the distribution of clarithromycin in the gastric juice of individuals with H. pylori infection. Methods: Eighteen H. pylori infected dyspeptic male volunteers without endoscopic lesions were enrolled in a study with an open, randomized, two-period crossover design and a 21-day washout period between phases. Plasma and gastric juice concentrations of clarithromycin in subjects with and without omeprazole pretreatment were measured by means of liquid chromatography coupled to tandem mass spectrometry. Results: The maximum concentration of clarithromycin (C max ) and the area under the time-concentration curve from 0 to 2 h (AUC 0-2h ) were significantly higher in gastric juice than in plasma. Omeprazole treatment further augmented clarithromycin C max and AUC 0-2h in gastric juice approximately 2-fold ( P < 0.05). Conclusions: Short-term treatment with omeprazole in H. pylori -positive volunteers increases the amount of clarithromycin transferred to the gastric juice, confirming a synergism between these drugs. Our results suggest the presence of an active transport mechanism for clarithromycin from plasma to the gastric lumen, which is influenced by omeprazole.     

耐信三联疗法对肝源性溃疡的疗效分析

目的观察耐信三联疗法对肝源性溃疡的治疗效果。方法2005年1月～2006年12月消化内科门诊病例中活动性胃溃疡患者168例,随机分为两组:肝源性溃疡组80例,非肝源性溃疡组88例,两组患者均处方埃索美拉唑片20mg,bid(4周) 克拉霉素500mg,bid(1周) 阿莫西林1000mg,bid(1周)。4周后随访患者,确定症状缓解率;同时复查胃镜,确定患者溃疡愈合情况。结果治疗4周后症状缓解率两组间无显著性差异(P>0.05),复查胃镜溃疡愈合例数两组间存在显著性差异(P<0.05)。结论肝源性溃疡药物治疗效果较差。可能需要延长疗程或辅之以其他方法。     

铝碳酸镁咀嚼片联合奥美拉唑治疗活动性胃溃疡组织学愈合质量的评价

背景：随着质子泵抑制剂的广泛应用，以及根除幽门螺杆菌（H．pylori）感染作为治疗消化性溃疡的主要手段，极大地提高了消化性溃疡的临床愈合率，但复发的难题仍待解决。溃疡愈合质量，尤其是组织学愈合质量受到许多学者关注。目的：观察活动性胃溃疡患者应用铝碳酸镁咀嚼片联合奥美拉唑与单用奥美拉唑治疗前后胃黏膜组织学变化。比较两组患者组织学溃疡愈合质量。方法：88例经胃镜检查证实伴有H．pylori感染的活动性胃溃疡患者随机分成治疗组和对照组。治疗第1周，两组患者均予H．pylori根除三联疗法，治疗组同时加服铝碳酸镁咀嚼片；第2～6周，治疗组给予铝碳酸镁咀嚼片联合奥美拉唑胶囊，对照组仅用奥美拉唑胶囊治疗；第7～8周，治疗组继续给予铝碳酸镁咀嚼片，对照组则停药。8周疗程结束后，两组患者复查胃镜。内镜下取胃溃疡周围黏膜（相当于原取材点处）组织2～4块，重新观察两组患者治疗后的胃黏膜组织学变化，着重从炎性细胞浸润程度和黏膜形态结构两个方面观察胃黏膜组织学恢复情况。结果：治疗组胃黏膜腺体密度和腺管形态改善程度较对照组好，且有统计学差异（P值分别为0．0351和0．0176）。结论：治疗活动期胃溃疡患者在根除H．pylori感染＋抗溃疡治疗后的第8周时点上．同时加用兼有抗酸和吸附胆汁作用的胃黏膜保护剂——铝碳酸镁咀嚼片，能更好地恢复胃黏膜形态结构，增强溃疡愈合的组织学质量．并有可能降低溃疡的远期复发率。     

Regular-dose versus High-dose Omeprazole in Peptic Ulcer Bleeding A Prospective Randomized Double-blind Study

Background: It has been suggested that profound acid inhibition along with endoscopic therapy might prevent rebleeding and reduce mortality in patients with peptic ulcer bleeding. The aim of the study was to test the possible equivalence of a high dose and the regular dose of omeprazole in peptic ulcer bleeding. Methods: We performed a prospective randomized double-blind study involving 142 patients with acute peptic ulcer bleeding (Forrest classification I-II: spurting or oozing bleeding, non-bleeding visible vessel, clot and black base). One-hundred-and-two (71.8%) patients received endoscopic treatment (adrenaline injection and/or heater probe) in pre-entry. Patients were randomly assigned to receive the regular dose of omeprazole intravenously (20 mg once a day for 3 days, i.e. 60 mg/72 h) or a high dose of omeprazole (80 mg bolus + 8 mg/h for 3 days, i.e. 652 mg/72 h). Rebleeding, surgery and death were the outcome measures. Results: Six (8.2%) of the 73 patients receiving the regular dose of omeprazole and 8 (11.6%) of the 69 patients receiving the high dose of omeprazole rebled ( P = 0.002 for equivalence, equivalence limit 0.15). Three (4.1%) of the former patients and 5 (7.2%) of the latter group underwent surgery. Four (5.5%) patients in the regular-dose and 2 (2.9%) in the high-dose group died within 30 days. Conclusion: Under the defined tolerance limits, the regular dose of omeprazole is as successful as a high dose in preventing peptic ulcer rebleeding.     

Factors that May Affect Treatment Outcome of Triple Helicobacter pylori Eradication Therapy with Omeprazole, Amoxicillin, and Clarithromycin

Factors affecting Helicobacter pylori eradication rate with omeprazole (OME), clarithromycin (CL), and amoxicillin (AMO) have not been extensively studied. We have investigated the effect of age, sex, smoking, ulcer disease, compliance with therapy, H. pylori colonization density, degree and activity of antral gastritis, the coexistence of corpus gastritis, and the presence of lymphoid follicles on H. pylori eradication rate. We studied 80 consecutive H. pylori-positive patients, with duodenal ulcer (N = 35) or nonulcer dyspepsia (N = 45) treated with OME 20 mg, CL 500 mg, and AMO 1 g, each given twice daily for 10 days. H. pylori was eradicated in 71/80 (88.8%, 95% CI 82–96%) patients. The regimen failed to eradicate the only strain (1.8%, 95% CI 0–5.2%) that was clarithromycin resistant. Multivariate discriminant analysis showed that two histological variables (Wilks = 0.74, ² = 23.41, df = 2, P < 0.001), absence of lymphoid follicles in routine gastric biopsies (F = 13.63, P < 0.001) and coexistence of antral and body gastritis (F = 13.68, P < 0.001), significantly increased H. pylori eradication rate. No other factor examined predicted H. pylori eradication with this regimen. Our data suggest that body gastritis is a positive and presence of lymphoid follicles in routine gastric biopsies is a negative predictive factor of treatment outcome with the omeprazole, clarithromycin, and amoxicillin regime.     

雷贝拉唑与奥美拉唑三联疗法根除幽门螺杆菌多中心、随机、双盲、平行对照研究

背景:新一代质子泵抑制剂雷贝拉唑具有较高的解离常数（pKa）,在抑酸方面起效更快,作用更持久稳定。目的:通过与奥美拉唑三联疗法比较,观察雷贝拉唑三联疗法根除幽门螺杆菌（H.pylori）和治疗十二指肠溃疡的疗效。方法:采用多中心、随机、双盲、平行对照研究方法,于2002年1～7月在5家医院进行。109例经胃镜检查确诊为十二指肠溃疡活动期并经快速尿素酶试验和病理学检查确定为H.pylori阳性的患者分为两组:雷贝拉唑（商品名:波利特）试验组（RAC组,53例）和奥美拉唑（商品名:洛赛克）对照组（OAC组,56例）。两组均先给予三联治疗:雷贝拉唑10mg或奥美拉唑20mg+阿莫西林1g+克拉霉素500mg,每日2次,连续7天,然后单独给予雷贝拉唑10mg,每日1次或奥美拉唑20g,每日1次,连续7天,并于用药结束后第28天复查胃镜并检测H.pylori。于用药后第1、2、3、6和42天对患者的上腹痛、反酸以及上腹烧灼感等症状进行评估。结果:101例患者完成全部治疗方案,8例失访。H.pylori根除率:病理学检查结果显示RAC组的H.pylori根除率为86.0％,OAC组为76.5％,两组间差异无显著性（P>0.05）。溃疡愈合率:PAC组的溃疡愈合率为92.0％,OAC组为76.5％,OAC组高于OAC组,两组间差异有显著性（P<0.05）。症状改善情况:两组从用药第1天起均能有效改善     

肝源性溃疡的临床特点与治疗探讨

目的：惭肝后肝硬化患者消化性溃疡的临床特点,探讨小剂量心得安对肝源性溃疡愈合的影响。方法：肝源性溃疡４５例,观察其发病年龄、临床表现、溃疡部位、ＨＰ感染率、合并出血率及溃疡愈合率等特点。随机分为治疗组２３例,用心得安＋泰胃美口服治疗;对照组２２例,用维生素Ｂ６＋泰胃美口服治疗。另外选单纯性消化性溃疡２２便,作为对照２组,治疗方法与Ｂ组相同。结果：肝源性溃疡发病较单纯性消化性溃疡晚１０年,溃疡部位以     

Triple Therapy with Azithromycin, Omeprazole, and Amoxicillin is Highly Effective in the Eradication of Helicobacter pylori: A Controlled Trial versus Omeprazole plus Amoxicillin

Background: Azithromycin is a new-generation, acid-stable macrolide antibiotic that achieves remarkably high concentrations in gastric tissue, persisting above the MIC₉₀ for Helicobacter pylori over a 5-day period after a single 500-mg oral dose. Methods: We evaluated a new metronidazole-free triple therapy with omeprazole 20 mg b.id. plus amoxicillin 1 g b.i.d. (both for 14 days) and azithromycin 500 mg mane (for the first 3 days only) (group I) versus double therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g t.i.d. , both for 14 days (group II). H. pylori status was determined by urease test and histology before and 6 wk after completion of therapy. Results: Ninety-two patients with peptic ulcer disease or nonulcer dyspepsia completed the study. H. pylori infection was eradicated in 44 (91.6%) of 48 patients randomized to receive triple therapy versus 26 (59.1%) of 44 who received double therapy ( p < 0.001). Smoking, but not omeprazole pretreatment, proved to be a risk factor for treatment failure only in the double-therapy group ( p = 0.05). All ulcers healed by the time of the 8-wk endoscopic control. Side effects, usually minor, were recorded in 12.5% and 9.1% of patients, respectively (NS), but therapy had to be discontinued in one patient in group I and in three in group II (NS). Conclusions: Two-week triple therapy with omeprazole, amoxicillin, and (for the first 3 days) low-dose azithromycin is highly effective in eradicating H. pylori. This regimen is safe and well-tolerated, and we recommend that it be used as first-line treatment, as an alternative to less-effective omeprazole-amoxicillin double therapy. Moreover, azithromycin appears to be a new, promising antibiotic for future innovative anti- H. pylori combinations.     

Seven-Day Triple Therapy with Omeprazole,Amoxycillin and Clarithromycin for Helicobacter pylori Infection in Haemodialysis Patients

Background: Triple therapy is accepted as the treatment of choice for Helicobacter pylori eradication, but there is no consensus on how long the therapy should be maintained in haemodialysis (HD(+)) patients. Our aims in this study were to evaluate the safety and efficacy of the 7-day triple therapy in HD(+) patients. Method: Forty-seven HD(+) and 55 HD(-) patients with dyspepsia underwent endoscopy. The prevalence of H. pylori was detected by Giemsa stain, followed by the urea breath test (UBT). H. pylori (+) patients were scheduled to undergo 7-day triple therapy and the success of eradication was investigated by UBT. Results: Forty-five (44%) patients were positive for H. pylori. Forty of them underwent triple therapy and 39 (98%) patients completed the treatment. Eradication was successful in 32 (82%) and unsuccessful in 7 (18%) patients. There was no significant difference between these groups in age, gender, endoscopic findings or HD, and only previous treatment was significant for eradication failure by univariate and multivariate logistic regression analysis. Side effects were observed in 2 (15%) of 13 HD(+) and 3 (11%) of 27 HD(-) patients, and one HD(-) patient had to stop medication because of severe nausea and vomiting. The eradication rate was 93% (28/30) in patients without previous treatment. The triple therapy was unsuccessful in 7 patients, and 4 of them again underwent 7-day triple therapy, but all resulted in failure. Conclusions: Seven-day triple therapy is safe and effective for primary treatment of H. pylori infection in both HD(+) and HD(-) patients, but a new treatment is necessary for patients with previous treatment.