Gursoy Olcay, Memiş Dilek, Sut Necdet
Department of Anaesthesiology and Reanimation, Trakya University Medical Faculty, Edime, Turkey.
Clin Drug Investig. 2008;28(12):777-82. doi: 10.2165/0044011-200828120-00005.
This study aimed to determine the effect of administration of a single-dose proton pump inhibitor (PPI) on gastric intramucosal pH (pHi), gastric juice volume and gastric pH in critically ill patients.
This prospective, randomized, double-blind, placebo-controlled study included 75 patients who were divided into five groups that received the following treatment: group C (n = 15), saline 100 mL; group O (n = 15), omeprazole 20 mg; group P (n = 15), pantoprazole 40 mg; group E (n = 15), esomeprazole 20 mg; and group R (n = 15), rabeprazole 20 mg. All treatments were administered nasogastrically in 100 mL of physiological saline. Measurements of gastric pHi, gastric juice volume and gastric pH were obtained immediately before and 2, 4 and 6 hours after administration of treatments. In addition, gastric content was aspirated and its volume was recorded.
Initial gastric pHi, gastric juice volume and gastric pH values were not statistically significantly different among the groups (p > 0.05). No statistically significant difference in gastric pHi was seen among the groups before or 2, 4 or 6 hours after saline or PPI administration. At hours 2, 4 and 6, gastric pH in the pantoprazole, esomeprazole and rabeprazole groups increased significantly, whereas gastric juice volume decreased significantly, compared with the omeprazole and placebo groups (p < 0.001). No statistically significant differences were seen between the pantoprazole, esomeprazole and rabeprazole groups.
This is the first study to show that single-dose pantoprazole, esomeprazole and rabeprazole are associated with greater gastric pH increase and greater gastric juice volume decrease than omeprazole in critically ill patients. Our study also suggests that PPIs do not affect gastric pHi measurements in critically ill patients and can be administered during pH monitoring.
本研究旨在确定给予危重症患者单剂量质子泵抑制剂（PPI）对胃黏膜内pH值（pHi）、胃液量和胃内pH值的影响。
这项前瞻性、随机、双盲、安慰剂对照研究纳入了75例患者，这些患者被分为五组，接受以下治疗：C组（n = 15），100 mL生理盐水；O组（n = 15），20 mg奥美拉唑；P组（n = 15），40 mg泮托拉唑；E组（n = 15），20 mg埃索美拉唑；R组（n = 15），20 mg雷贝拉唑。所有治疗均通过鼻胃管以100 mL生理盐水给药。在给药前以及给药后2、4和6小时立即测量胃pHi、胃液量和胃内pH值。此外，抽取胃内容物并记录其体积。
各组初始胃pHi、胃液量和胃内pH值在统计学上无显著差异（p > 0.05）。在给予生理盐水或PPI之前以及给药后2、4或6小时，各组胃pHi在统计学上无显著差异。与奥美拉唑组和安慰剂组相比，在2、4和6小时时，泮托拉唑组、埃索美拉唑组和雷贝拉唑组的胃内pH值显著升高，而胃液量显著减少（p < 0.001）。泮托拉唑组、埃索美拉唑组和雷贝拉唑组之间未见统计学显著差异。
本研究首次表明，在危重症患者中，单剂量泮托拉唑、埃索美拉唑和雷贝拉唑比奥美拉唑能使胃内pH值升高幅度更大，胃液量减少幅度更大。我们的研究还表明，PPI不影响危重症患者的胃pHi测量，并且可以在pH监测期间给药。
