Poleski M H, Spanier A H
Am J Gastroenterol. 1986 Feb;81(2):107-11.
To assess the efficacy of cimetidine versus Mylanta II in the prevention of stress erosions, 44 patients at risk were randomized to receive cimetidine 300 mg/6 h intravenously to a maximum of 400 mg/4 h; or Mylanta II 30 ml/h through a nasogastric tube to a maximum of 90 ml/h. The minimum dose of medication was used to maintain hourly gastric pH greater than or equal to 4. All patients were to be endoscoped after 72 h and erosions graded by an endoscopist who had no knowledge of their treatment regime. Grade 3 or 4 erosions occurred in five of 21 cimetidine-treated patients and eight of 16 antacid-treated patients (p greater than 0.05). A gastric pH greater than or equal to 4 was maintained 79.5% of the time by cimetidine and 97.9% of the time by Mylanta II (p less than 0.001). Cimetidine and antacids are equal in the prevention of stress erosions although Mylanta II is superior in hourly pH control. Hourly pH control does not entirely explain the beneficial effect of cimetidine in the prevention of stress ulcers. There was no significant bleeding in this study. Fatalities in patients at risk of developing stress ulcers result from the underlying disease, not from hemorrhage from stress-induced mucosal lesions. In critically ill patients, endoscopic examination should be restricted to the rare case with manifest hemorrhage.
为评估西咪替丁与迈兰塔II在预防应激性溃疡方面的疗效，将44例有风险的患者随机分组，一组静脉注射西咪替丁300mg/6小时，最大剂量为400mg/4小时；另一组通过鼻胃管以30ml/小时的速度输注迈兰塔II，最大速度为90ml/小时。使用最低剂量的药物来维持每小时胃pH值大于或等于4。所有患者在72小时后进行内镜检查，由不了解其治疗方案的内镜医师对溃疡进行分级。在21例接受西咪替丁治疗的患者中，有5例出现3级或4级溃疡；在16例接受抗酸剂治疗的患者中，有8例出现3级或4级溃疡（p>0.05）。西咪替丁维持胃pH值大于或等于4的时间为79.5%，迈兰塔II为97.9%（p<0.001）。西咪替丁和抗酸剂在预防应激性溃疡方面效果相当，尽管迈兰塔II在每小时的pH值控制方面更具优势。每小时的pH值控制并不能完全解释西咪替丁在预防应激性溃疡方面的有益作用。本研究中未出现明显出血情况。有发生应激性溃疡风险的患者死亡是由基础疾病导致的，而非应激性黏膜损伤引起的出血。在重症患者中，内镜检查应仅限于出现明显出血的罕见病例。
