24小时胃内酸度监测评价多种抑酸剂静脉使用对十二指肠溃疡患者的抑酸效果

目的　对比各种常用抑酸剂对十二指肠溃疡出血患者胃酸的抑制效果。方法　运用随机、开放的方法分析５０ 例十二脂肠溃疡出血患者，分别使用奥美拉唑静脉滴注、法莫替丁静脉注射、雷尼替丁静脉注射、西咪替丁静脉注射或滴注。持续监测患者２４ 小时胃内ｐＨ 动态变化的情况、不同胃内ｐＨ值持续时间的百分率、２４ 小时平均胃内ｐＨ 和中位ｐＨ 值。结果　只有奥美拉唑８０ｍｇ／天组可达到胃内平均ｐＨ 和中位ｐＨ 均＞６ ，法莫替丁８０ｍｇ／天组可达到胃内平均ｐＨ 和中位ｐＨ 均＞ ４，其他治疗组均未达到ｐＨ＞ ４ 。２４ 小时胃内ｐＨ＜ ４ 、ｐＨ＜ ５、ｐＨ＜ ６ 时间所占百分比依次递增为：奥美拉唑８０ｍｇ／天组、法莫替丁８０ｍｇ／ 天组、雷尼替丁２００ｍｇ／天组、西咪替丁８００ｍｇ／天组。各Ｈ２ 受体拮抗剂组与奥美拉唑静脉滴注组比较，差异均有显著性。结论　静脉使用质子泵抑制剂的抑酸效果明显优于Ｈ２ 受体拮抗剂，尤其是奥美拉唑静脉滴注胃内ｐＨ 提高持续的时间较长。

Comparative effects of intravenous infusion of omeprazole and H 2 receptor antagonists on suppressing intragastric pH and the outcome of bleeding duodenal ulcer patients

Objective To evaluate the effects on 24 hour intragastric pH levels of infusions with omeprazole and H 2 receptor antagonists in bleeding duodenal ulcer patients.Methods 50 patients with active bleeding duodenal ulcer were randomly assigned to receive one of the four treatment regimens. They were omeprazole 40mg iv infusion q12h, famotidine 40mg iv q12h, ranitidine 50mg iv q6h, cimetidine 200mg iv q6h etc. Intragstric pH values were monitored in each subject at baseline and continuously for 24 hours after intravenous regimen.Results Only omeprazole 40mg iv infusion q12h group produced mean and median intragastric pH value above 6. Famotidine 40mg iv q12h group had mean and median intragastric pH above 4. Other groups' pH were below 4, and no significant differences could be found between them. The mean percentages of time of imtagastric pH during 24 hours <4, <5 and <6 were in the increasing order of the groups of omeprazole 40mg iv infusion q12h, famotidine 40mg iv q 12h, ranitidine 50mg q6h, and cimetidine 200mg iv q6h.Conclusion Intravenous use of omeprazole in active duodenal ulcer bleeding is superior to H 2 receptor antagonists, the increase of intragastric pH maintains for a longer period.