Olsen K M, Devlin J W
College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA.
Aliment Pharmacol Ther. 2008 Aug 1;28(3):326-33. doi: 10.1111/j.1365-2036.2008.03728.x.
While proton pump inhibitors are frequently administered in the intensive care unit, the pharmacodynamic response of acid suppression between the enteral and intravenous (IV) route is unknown.
To compare the pharmacodynamic response between enteral and IV lansoprazole in intensive care unit patients requiring stress ulcer prophylaxis therapy.
Adult mechanically ventilated patients were randomized to receive 72 h of daily enteral [lansoprazole oral disintegrating tablet (LODT) 30 mg mixed in 10 mL of water via a nasal gastric tube] or IV lansoprazole (30 mg over 30 min) therapy. Serial blood samples were collected after the first and third dose and analysed for pharmacokinetic parameters. Pharmacodynamic determination of intragastric pHmetry began prior to the first dose and continued for 72 h using a single channel pH microelectrode.
Nineteen intensive care unit patients were randomized [LODT (n = 10); IV-L (n = 9)]. LODT bioavailability was 76%. LODT maintained gastric pH > 4 longer than IV-L at both 24 h (7.4 vs. 5.9 h; P = 0.039) and 72 h (10.4 and 8.9 h; P = 0.046) and resulted in a greater average pH over the first 24 h (3.67 vs. 2.89; P = 0.03).
Despite a lower bioavailability, enteral lansoprazole suppresses acid in intensive care unit patients to a greater extent than IV lansoprazole.
虽然质子泵抑制剂在重症监护病房中经常使用，但肠内和静脉注射途径的胃酸抑制药效学反应尚不清楚。
比较在需要预防应激性溃疡治疗的重症监护病房患者中，肠内和静脉注射兰索拉唑的药效学反应。
成年机械通气患者被随机分为接受72小时每日肠内[兰索拉唑口腔崩解片（LODT）30毫克通过鼻胃管混入10毫升水中]或静脉注射兰索拉唑（30毫克在30分钟内）治疗。在第一剂和第三剂后采集系列血样并分析药代动力学参数。使用单通道pH微电极在第一剂之前开始进行胃内pH值测定的药效学测定，并持续72小时。
19名重症监护病房患者被随机分组[LODT组（n = 10）；静脉注射兰索拉唑组（n = 9）]。LODT的生物利用度为76%。在24小时（7.4对5.9小时；P = 0.039）和72小时（10.4和8.9小时；P = 0.046）时，LODT维持胃pH值> 4的时间比静脉注射兰索拉唑更长，并且在最初24小时内导致更高的平均pH值（3.67对2.89；P = 0.03）。
尽管生物利用度较低，但肠内兰索拉唑在重症监护病房患者中比静脉注射兰索拉唑更能抑制胃酸。
