不同剂量泮托拉唑对消化性溃疡并出血高危患者胃内 pH 的影响

摘要

目的：比较不同剂量泮托拉唑对消化性溃疡并出血（PUB）高危患者胃内pH值的影响。方法19例经胃镜确诊为 PUB 的患者（Forrest 分级 Ib-Ⅱb）分为2组，分别予静脉使用大剂量泮托拉唑（首剂80 mg 静脉注射，然后以8 mg／h 的速度持续静脉注射）和常规剂量泮托拉唑（首剂40 mg 静脉注射，然后以4 mg／h 的速度持续静脉注射）治疗，并对其进行24 h 动态胃酸监测。其中，大剂量组8例，常规剂量组11例。观察2组患者24 h 胃内 pH 达到6.0的时间，并比较其 pH ＞6.0占总监测时间百分比。结果2组患者一般情况（包括年龄、性别、幽门螺杆菌感染情况、溃疡类型、内镜分级等）比较差异均无统计学意义。大剂量组患者胃内 pH 达到6.0时间为（30.50±4.84） min，常规剂量组为（57.09±13.56）min，2组比较差异有统计学意义（P ＜0.01）。大剂量组患者胃内 pH ＞6.0所占时间百分比为95.42％（44.36％），常规剂量组为42.15％（40.14％），2组比较差异有统计学意义（P ＝0.006）。结论大剂量和常规剂量静脉使用泮托拉唑均能使 PUB 高危患者胃内pH 值达到6.0以上，但大剂量组起效更快且持续时间更长。%Objective To evaluate the effect of different doses of pantoprazole on intra-gastric pH in patients with a high risk of peptic ulcer bleeding (PUB).Methods Nineteen patients diagnosed with PUB (Forrest grading:Ib-IIb)by gastroscope were divided into the high-(n =8)and regular-dose groups(n =11).In the high dose group,eight patients were intravenously administered with pantoprazole (80 mg bolus and then continuous infusion at speed of 8 mg/h)and 11 in the regular dose group were delivered with intravenous injec-tion of pantoprazole (40 mg bolus and then continuous infusion at a speed of 4 mg/h).Intra-gastric pH in all patients was monitored for 24 h.The mean time when the intra-gastric pH reached 6.0 (within 24 h)and the percentage of patients with intra-gastric pH >6.0 were observed.Results The general data including age, gender,helicobacter pylori infection,type of ulcer and endoscopic classification,etc.did not significantly dif-fer between two groups (all P >0.05).The mean time when intra-gastric pH reached 6.0 was approximately (30.50 ±4.84)min in the high dose group,which was significantly shorter than (57.09 ±13.56)min in the regular dose group (P <0.01).The percentage of patients with intra-gastric pH >6.0 in the high dose group was 95.42% (44.36%),significantly higher compared with 42.15% (40.14%)in the regular dose group (P =0.006).Conclusions Intravenous administration of pantoprazole at a high and regular dose can both in-crease intra-gastric pH to above 6 in patients with a high risk of PUB,whereas a high dose of pantoprazole yields faster and longer effect compared with a regular dosage.