不同剂量艾司奥美拉唑治疗急性非静脉曲张性上消化道出血的随机对照试验

程进伟　余志金　陈惠新

【摘要】 目的：不同剂量艾司奥美拉唑治疗急性非静脉曲张性上消化道出血的临床效果和安全性。方法：选取2017年4-10月本院新诊断急性非静脉曲张性上消化道出血患者174例，按随机数字表法分为观察组和对照组，每组87例。观察组给予80 mg艾司奥美拉唑治疗，对照组给予40 mg艾司奥美拉唑治疗。比较两组不同时间点止血率、胃pH值及不良反应发生率。结果：观察组给药后4、6、12 h止血率均高于对照组，差异均有统计学意义（P<0.05）;两组给药后18、24、48 h止血率比较，差异均无统计学意义（P>0.05）。观察组给药后4、6、12 h胃pH值均高于对照组，差异均有统计学意义（P<0.05）;两组给药后18、24、48 h胃pH值比较，差异均无统计学意义（P>0.05）。两组不良反应发生率比较，差异无统计学意义（P>0.05）。结论：对于急性非静脉曲张性上消化道出血，80 mg与40 mg艾司奥美拉唑静脉滴注相比起效更快，且不增加不良反应。

【关键词】 急性非静脉曲张性上消化道出血; 艾司奥美拉唑; 剂量; 疗效; 安全性

【Abstract】 Objective：To explore the curative effect and safety of different doses of Esomeprazole in treatment of acute nonvaricealupper gastroint estinal bleeing.Method：174 patients with acute nonvaricealupper gastroint estinal bleeing were selected from April to October 2017 in our hospitals，and they were divided into the observation group and the control group according to the random number table method，87 cases in each group.The observation group was treated with 80 mg Esomeprazole，the control group was treated with 40 mg Esomeprazole.The hemostatic rate，intragastric pH of two groups at different time points were compared，and the incidence of adverse reactions of two groups was compared.Result：4，6，12 h after injection，the hemostatic rate of the observation group were higher than those in the control group，the differences were statistically significant（P<0.05）.18，24，48 h after injection，the hemostatic rate between two groups were compared，the differences were not statistically significant（P>0.05）.4，6，12 h after injection，the intragastric pH of the observation group were higher than those in the control group，the differences were statistically significant（P<0.05）.18，24，48 h after injection，the intragastric pH between two groups was compared，the differences were not statistically significant（P>0.05）.The inciclence of adverse reactions was compared between two groups，the difference was not statistically significant（P>0.05）.Conclusion：For acute nonvaricealupper gastroint estinal bleeding，80 mg of Esomeprazole is more effective than 40 mg of Esomeprazole，and does not increase adverse reactions.

【Key words】 Acute nonvaricealupper gastroint estinal bleeding; Esomeprazole; Dose; Curative effect; Safety

First-authors address：The Central Peoples Hospital of Huizhou City，Huizhou 516001，China

doi：10.3969/j.issn.1674-4985.2019.12.033

急性非靜脉曲张性上消化道出血是指屈氏韧带以上消化道的非静脉曲张性疾患引起的出血，是临床最常见的危重急症之一[1-2]。其中胃部出血及十二指肠出血在整个急性非静脉曲张性上消化道出血中所占比例最高，主要症状表现为呕血、黑便，失血情况严重者可伴见急性周围循环障碍及多器官功能障碍综合征[3-6]。研究表明，静脉注射艾司奥美拉唑能为急性非静脉曲张性上消化道出血的止血机制发挥创造条件[7-9]。然而，静脉注射艾司奥美拉唑能急性非静脉曲张性上消化道出血的最佳使用剂量仍然存在争议[10]。为此，本院开展本研究，旨在通过循证医学的研究方法探讨不同剂量艾司奥美拉唑治疗急性非静脉曲张性上消化道出血的临床疗效和安全性，为临床应用艾司奥美拉唑治疗急性非静脉曲张性上消化道出血提供科学依据。现报道如下。