Bresalier R S, Grendell J H, Cello J P, Meyer A A
Department of Medicine, University of California, San Francisco.
Am J Med. 1987 Sep 28;83(3B):110-6. doi: 10.1016/0002-9343(87)90839-4.
Seventy-four medical and surgical patients having a minimum of two risk factors for stress-related gastric mucosal bleeding were prospectively selected randomly to receive prophylaxis by antacid titration (to maintain a gastric pH of more than 4) or with sucralfate suspension (1 g/10 ml every four hours). Gastric aspirates were monitored every two hours for pH and overt and occult bleeding. Despite a significantly greater severity of illness in the sucralfate group (p less than 0.01), no significant difference in overt or occult bleeding between the groups could be demonstrated. Low-grade occult blood loss occurred frequently in both groups, but only one of the 74 patients (four risk factors, sucralfate group) had significant stress-related bleeding as defined by preset criteria and documented by endoscopy. The effectiveness of sucralfate appeared unrelated to acid neutralization in keeping with its classification as a cytoprotective agent. There were eight antacid-related side effects (four severe diarrhea, four hypermagnesemia), and none related to sucralfate. Sucralfate suspension was safe and effective and had fewer side effects than antacid titration for the prophylaxis of stress-related bleeding in critically ill patients.
前瞻性随机选取74例至少有两个与应激性胃黏膜出血相关危险因素的内科和外科患者，分别接受抗酸剂滴定法（维持胃pH值大于4）或硫糖铝混悬液（每4小时1g/10ml）进行预防。每两小时监测胃吸出物的pH值以及显性和隐性出血情况。尽管硫糖铝组患者的病情严重程度显著更高（p小于0.01），但两组之间在显性或隐性出血方面未显示出显著差异。两组均频繁出现轻度隐性失血，但74例患者中只有1例（有四个危险因素，硫糖铝组）出现符合预设标准且经内镜证实的显著应激相关出血。硫糖铝的有效性似乎与酸中和无关，这与其作为细胞保护剂的分类相符。有8例与抗酸剂相关的副作用（4例严重腹泻，4例高镁血症），且无与硫糖铝相关的副作用。硫糖铝混悬液安全有效，在预防重症患者应激相关出血方面比抗酸剂滴定法副作用更少。
