不同剂量奥美拉唑防治应激性消化道黏膜损伤的对比研究

潘素华+张丽+何建生+毛可珍��

【摘要】目的对比分析不同剂量奥美拉唑防治应激性消化道黏膜损伤的效果。

方法选择2014年1月～2016年1月重症监护室（ICU）收治的180例患者，随机分为对照组和观察组（各90例）。两组患者均给予奥美拉唑以预防和治疗应激性消化道黏膜损伤，其中对照组给予常规剂量，观察组则给予大剂量。治疗3 d后，对比两组患者治疗前后胃酸酸碱度变化水平、血液指标变化、胃液潜血试验、止血效果及不良反应的发生率。

结果治疗后两组患者胃液酸碱度均明显升高，且观察组上升更为显著；观察组患者抑酸率（以胃酸pH≥6为有效）、血液各项指标、胃液潜血试验阴性率、治疗总有效率明显高于对照组，差异均有统计学意义（P<0.01）；两组接受治疗后均未出现严重的不良反应。

结论大剂量奥美拉唑能有效预防和治疗应激性消化道黏膜损伤及其导致的出血症状，且无显著的安全问题，值得临床应用推广。

【关键词】奥美拉唑；剂量；应激性消化道黏膜损伤

中图分类号：R57文献标识码：ADOI：10.3969/j.issn.10031383.2017.02.020

【Abstract】ObjectiveTo compare and analyze effects of different doses of omeprazole for prevention and treatment of stressinduced gastrointestinal mucosal injury.

Methods180 cases of patients treated in intensive care unit（ICU） from January，2014 to January，2016 were selected and randomly divided into control group and observation group （90 cases in each group）.Both groups were given omeprazole to prevent and treat stressinduced gastrointestinal mucosal injury，the control group were given conventional dose，and the observation group were given large dose.After 3 days of treatment，changes of gastric acidity，changes in blood parameters，gastric blood occult blood test，hemostasis effects and incidence of adverse reactions between the two groups before and after treatment were compared.

ResultsAfter treatment，the gastric acidity of the two groups significantly increased，and that of the observation group increased more significantly.The acid inhibition rate（with gastric acid pH≥6 as effective），blood parameters，negative rate of gastric blood occult blood test and total effective rate of the observation group were significantly higher than those of the control group，difference was statistically significant （P<0.01）.There was no obvious and serious adverse reactions in the two groups after the treatment.

ConclusionHighdose omeprazole can effectively prevent and treat stressinduced gastrointestinal mucosal injury and the resulting bleeding symptoms without significant safety problems.Thus，it is worthy of clinical application.

【Key words】omeprazole；dose；stressinduced gastrointestinal mucosal injury

應激性消化道黏膜损伤主要是指在严重外伤、大手术、颅脑内外伤、大面积烧伤感染或休克等过程中，由于机体强烈的应激反应引起神经、体液以及内分泌功能紊乱，导致交感神经过度兴奋，从而促使儿茶酚胺和肾上腺皮质激素大量释放，使消化道血管明显收缩致使消化道黏膜原有的保护与损伤机制失衡，最终形成了以消化道溃疡或黏膜糜烂、坏死为特征的严重并发症[1]。常见于胃黏膜，或可侵及十二指肠，偶有累及食管，病变部位常出现充血、水肿、糜烂和浅表溃疡，严重者可侵及黏膜下，导致损伤部位发生不同程度的出血，亦即上消化道出血[2]。特别是当病变侵蚀大血管时，易引发大出血并导致低血容量性休克，另外还可引起胃穿孔以及全身炎症反应、甚至出现多器官功能障碍（MODS），临床死亡率极高且预后极差[3]。临床实践已经证明质子泵抑制剂（PPI）可以有效预防和治疗应激性消化道溃疡及出血[4]，故本文对不同剂量的奥美拉唑防治应激性消化道黏膜损伤进行观察研究，现报告如下。