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目的观察急性脑梗死患者应激性溃疡的夜间酸突破(NAB)现象并探讨防治的方法。方法将入选的80例急性脑梗死患者随机分为4组,每组20例。A组:静脉滴注奥美拉唑40 mg,2次/d;B组:口服(或胃管内灌注)奥美拉唑片40 mg,1次/d;C组:口服(或胃管内灌注)奥美拉唑片20 mg,2次/d;D组:静脉滴注奥美拉唑40 mg,2次/d+静脉滴注西咪替丁600 mg,1次/晚,于第6天早上监测患者24 h胃内pH值。结果 (1)D组患者无NAB发生,A组只有1例发生,C组有3例,B组有5例,D组NAB的发生率显著低于其他各组(P<0.01);(2)4组患者的24 h平均胃内pH值、夜间平均胃内pH值、24 h平均胃内pH<4.0时段占24 h的百分比、夜间平均胃内pH<4.0时段占24 h的百分比比较,差异均有统计学意义(P<0.05)。患者24 h平均胃内pH值、夜间平均胃内pH值D组显著高于B、C组(P<0.01);24 h平均胃内pH<4.0时段占24 h的百分比及夜间平均胃内pH<4.0时段占24 h的百分比D组显著低于B、C组(P<0.01)。24 h平均胃内pH值及24 h平均胃内pH<4.0时段占24 h的百分比D组与A组比较,差异无统计学意义(P>0.05);夜间平均胃内pH值D组高于A组(P<0.05),夜间平均胃内pH<4.0时段占24 h的百分比D组低于A组(P<0.05)。(3)A、B、C、D 4组患者应激性溃疡出血的发生率依次为5%(1/20)、20%(4/20)、15%(3/20)和0,4组应激性溃疡的发生率间差异有统计学意义(P<0.05)。应激性溃疡的发生率B组>C组>A组>D组,差异均有统计学意义(P<0.05)。结论急性脑梗死患者在应激性溃疡的预防中单用奥美拉唑标准剂量多发生NAB,增加奥美拉唑用药次数、剂量及联用西米替丁可以降低NAB的发生,有利于应激性溃疡的预防及患者的预后。
Objective To observe the nocturnal acid breakthrough (NAB) of stress ulcer in patients with acute cerebral infarction and explore the methods of prevention and treatment. Methods Eighty patients with acute cerebral infarction were randomly divided into 4 groups with 20 cases in each group. Group A: Omeprazole 40 mg twice a day for intravenous drip; Group B: Omeprazole 40 mg once daily for oral or intragastric administration; Group C: Oral (or gastric tube Group D: intravenous infusion of omeprazole 40 mg, 2 times / d + intravenous cimetidine 600 mg, 1 time / night, in the On the 6th morning, the patients were monitored for gastric intragastric pH 24 hours. Results (1) There was no NAB in group D, only 1 case in group A, 3 cases in group C, 5 cases in group B, and the incidence of NAB in group D was significantly lower than that in other groups (P <0.01) ) The average intra-gastric pH value of 24 hours, the average intra-gastric pH value at night, the average intra-gastric pH <4.0 for 24 hours, the percentage of total intra-gastric pH <4.0 for 24 hours and the average intra-gastric pH <4.0 for night for 24 hours accounted for 24- The differences were statistically significant (P <0.05). The average intra-gastric pH value at 24 h and the average intra-gastric pH value at night in group D were significantly higher than those in group B and C (P <0.01). The mean intra-gastric pH <4.0 for 24 h and the mean intra-night pH The percentage of <4.0 in 24 h was significantly lower in group D than in group B and C (P <0.01). The mean intra-gastric pH value at 24 hours and the average intra-gastric pH value at 24-hour <4.0 accounted for 24 hours. There was no significant difference between group D and group A (P> 0.05) Group A (P <0.05). The average nighttime mean intragastric pH <4.0 was 24 hours. The percentage of group D was lower than that of group A (P <0.05). (3) The incidence of stress ulcer bleeding in group A, B, C and D was 5% (1/20), 20% (4/20), 15% (3/20) and 0,4 There was significant difference between the incidence of stress ulcer (P <0.05). The incidence of stress ulcer in group B> C group> A group> D group, the differences were statistically significant (P <0.05). Conclusions Patients with acute cerebral infarction in the prevention of stress ulcer with omeprazole standard dose more NAB, increasing the number of omeprazole medication, the dose and the combination of cimetidine can reduce the occurrence of NAB, is conducive to Prophylaxis of irritable ulcer and prognosis of patients.