探讨重型颅脑损伤后应激性溃疡的发病机制及防治措施

目的探讨重型颅脑损伤后应激性溃疡的发生机制及预防措施。方法随机选取该院2010年1月—2013年1月收治的因重型颅脑损伤所致应激溃疡患者84例（住院时间〉7d,入院后均进行常规降颅压,肠内营养支持治疗及止血治疗）,随机分为ABCD四组,A组为无药物组,B组予抑酸剂泮托拉唑,C组予胃粘膜保护剂硫糖铝,D组予泮托拉唑＋硫糖铝,①观察A组患者胃粘膜内pH值（PHi）,胃液pH值,血糖值与出血率及病死率的关系;②观察四组患者胃液PH值,应激性溃疡出血率及溃疡愈合时间。结果①PHi值降低、pH值降低及血糖升高时出血率及病死率明显升高;②出血率：A组最高并明显高于B、C、D组,D组最低,胃液pH值：A组最低并明显低于B、C、D组,D组最高;溃疡愈合时间：A组时间最长并明显高于B、C、D组,D组时间最短。结论①重型颅脑损伤后应激性溃疡的发病机制与交感神经兴奋性增强,胃粘膜损害,高血糖等因素有关;②重型颅脑损伤后应激性溃疡的防治措施应在常规降颅压,肠内营养支持治疗及止血治疗后加用抑酸药与胃粘膜保护剂联合用药以更好的降低出血率及病死率。

The Study of the Pathogenesis and Prevention Measures of Stress Ulcer after Severe Craniocerebral Injury

Objective To explore the pathogenesis and preventive measures of stress ulcer after severe craniocerebral injury. Methods 84 cases of stress ulcer patients after severe craniocerebral injury admitted in our hospital from January, 2010 to January, 2013 （whose hospital stays 7d; normal reduction of intracranial pressure, enteral nutrition support treatment and hemostasis treatment were given to them） were randomly divided into four groups, group A, group B, group C and group D. Group A was given no drug; group B was given antacid pantoprazole; group C was given gastric mucosa protective agent sucralfate and Group D was given pantoprazole and sucralfate. ① The relationship among gastric mucosa PH value （PHi）, gastric juice PH value, blood glucose level and bleeding rate and fatality rate of group A were observed and analyzed. ② Gastric juice PH values, stress ulcer＇s bleeding rate and ulcer healing time of the four groups were observed. Results ①Along with the decreasing of PHi value and PH value and the rising of blood sugar, bleeding rate and fatality rate raised obviously. ② The bleeding rate： The bleeding rate of group A was the highest, and significantly higher than that of B, C, and D group. Group D had the lowest bleeding rate. The pH value of gastric juice： The pH value of gastric juice of group A was the lowest, and significantly lower than that of B, C, and D group. Group D had the highest pH value. Ulcer healing time： The ulcer healing time of group A was the longest, and significantly longer than that of B, C, and D group. Group D had the shortest healing time. Conclusion ①The pathogenesis of stress ulcer after severe craniocerebral injury is related to factors such as sympathetic nerve excitability enhancement, gastric mucosa damage and hyperglycemia. ② With regard to the prevention measures of stress ulcer after severe craniocerebral injury, inhibitory acid drugs and gastric mucosa protectant should be given to patients who have received normal reduction of intracranial pressure, enteral nutrition support treatment and hemostasis treatment, which can reduce the bleeding rate and fatality rate of the patients better.