Schentag J J, Carter C A, Welage L S
State University of New York, Buffalo.
DICP. 1989 Oct;23(10 Suppl):S36-9. doi: 10.1177/1060028089023s1006.
Therapeutic intervention for the prevention of stress-related mucosal damage (SRMD) is currently directed at decreasing mucosal exposure to endogenous hydrochloric acid. We conducted a double-blind, parallel-group study in critically ill patients to investigate the comparative safety and acid-suppressant properties of the intravenously administered H2-receptor antagonists cimetidine and famotidine. This is a preliminary analysis. Study patients received either famotidine 20 mg q12h or cimetidine 300 mg q6h or q12h. Cimetidine dosing intervals were based upon the degree of renal and hepatic dysfunction due to pharmacokinetic considerations. In critically ill patients with severe renal impairment, a pH of greater than or equal to 4.0 was maintained more consistently with famotidine 20 mg q12h compared with treatment with cimetidine. In terms of safety, a greater number of patients receiving cimetidine reported adverse clinical experiences than those receiving famotidine and a greater number of cimetidine patients had to be withdrawn from the study when compared with famotidine patients. In conclusion, preliminary results of this study suggest that famotidine has superior acid-suppressant properties and a better safety profile when used intravenously for the prevention of SRMD in critically ill patients.
目前，预防应激相关黏膜损伤（SRMD）的治疗干预措施旨在减少黏膜与内源性盐酸的接触。我们对重症患者进行了一项双盲平行组研究，以调查静脉注射H2受体拮抗剂西咪替丁和法莫替丁的相对安全性及抑酸特性。这是一项初步分析。研究患者分别接受每12小时20毫克法莫替丁、每6小时或每12小时300毫克西咪替丁治疗。出于药代动力学考虑，西咪替丁的给药间隔根据肝肾功能不全程度而定。在重症且伴有严重肾功能损害的患者中，与西咪替丁治疗相比，每12小时20毫克法莫替丁能更持续地维持pH值大于或等于4.0。在安全性方面，与接受法莫替丁治疗的患者相比，更多接受西咪替丁治疗的患者报告了不良临床经历，且更多接受西咪替丁治疗的患者不得不退出研究。总之，本研究的初步结果表明，在静脉注射用于预防重症患者的SRMD时，法莫替丁具有更优的抑酸特性和更好的安全性。
