善宁对十二指肠溃疡出血者胃内pH的影响

目的对比善宁和奥美拉唑对十二指肠溃疡(DU)出血者胃内24hpH的影响,观察其能否增进内镜下注射止血的疗效.方法(1)DU出血者随机分为3组,各组8例善宁1组(静注0.1mg,后25μg/h连续恒速静滴);善宁2组(静注0.1mg,后42μg/h连续恒速静滴);奥美拉唑组(40mg静注,后8.0mg/h恒速滴入).均用药24h.(2)消化性溃疡活动性出血行内镜下肾上腺素注射止血,同时随机分为善宁组42例(同善宁组1)和奥美拉唑组54例(同上),静滴72h,最后口服奥美拉唑(20mg,日2次).结果(1)善宁2组胃内pH平均值(6.7±0.5)和中位值(6.9±0.4)与奥美拉唑组(6.8±0.4)(7.0±0.4)间差异无显著意义,两组胃内pH>4、>6和>7的百分比也未见显著差异,但善宁1组各上述参数均显著低于前二组.(2)溃疡出血行内镜注射止血后,善宁治疗与奥美拉唑相比,输血量(0.7±0.5L比0.6±0.4L)、再出血率(11.6%比12.9%)、急诊手术率(7.1%比3.7%)和病死率(2.3%比3.7%)二组间差异无显著意义.结论善宁可有效抑制胃酸分泌,但临床常用剂量难以把胃内pH提升达止血所需的最佳状况,需大剂量(1.1mg/d)才可达此目的.

Effect of octreotide on intragastric pH in patients with duodenal ulcer bleeding

OBJECTIVE: To evaluate the effect of octreotide on the intragastric pH of patients with duodenal ulcer bleeding during the period of 24 hours and to observe if it can advance the effect of hemostasis by endoscopic injection of epinephrine. METHODS: Twenty-four patients with duodenal ulcer bleeding were randomly divided into three groups, eight in each. Patients in group 1 received an intravenous injection of 0.1 mg of octreotide followed by continuous intravenous drip of octreotide at a constant speed of 25 microg/h for 24 hours. The patients in group 2 received an intravenous injection of 0.1 mg of octreotide followed by continuous intravenous drip of octreotide at a constant speed of 42 microg/h for 24 hours. The patients in group 3 received an intravenous injection of 40 mg of omeprazole followed by continuous intravenous drip of omeprazole at a constant speed of 8 mg/h for 24 hours. Intragastric pH was continuously recorded with a pH meter. The patients with active ulcer bleeding was treated with injection of epinephrine via endoscope and then received intravenous drip of octreotide (with the same dosage as in group 1, n = 42) or omeprazole (with the same dosage as in group 3, n = 54) for 72 hours and were given omeprazole (20 mg Bid). RESULTS: The mean and median intragastric pH values among the patients in group 2 treated by a larger dosage of octreotide (6.7 +/- 0.5 and 6.9 +/- 0.4) were similar to those in the group 3 treated by omeprazole (6.8 +/- 0.4 and 7.0 +/- 0.4). There was no statistically significant difference between these two groups in percentage of intragastric pH above 4, 6, and 7 The mean and median of intragastric pH among the patients in group 1 treated by a smaller dosage of octreotide were statistically significantly smaller (5.2 +/- 0.5 and 5.4 +/- 0.4) than those in the omeprazole group. There was no statistically significant difference between octreotide treatment and omeprazole treatment in terms of volume of blood transfusion (0.7 +/- 0.5 vs. 0.6 +/- 0.4 L), rebleeding rate (11.6% vs. 12.9%), emergency operation rate (7.1% vs. 3.7%), and mortality (2.3% vs. 3.7%). CONCLUSION: Octreotide effectively inhibits the secretion of gastric acid. However, the dosage in common use clinically fails to increase the intragastric pH to the best situation needed for effective hemostasis. Only a large dosage (1.10 mg/d) works.