Brunner G, Luna P, Thiesemann C
University Medical School, Hannover, Germany.
Aliment Pharmacol Ther. 1995;9 Suppl 1:47-50. doi: 10.1111/j.1365-2036.1995.tb00784.x.
A few years ago, patients with bleeding peptic ulcers were referred to the surgeon if the bleeding did not stop. Today we have two promising new approaches to prevent emergency surgery. One is endoscopic intervention, the other is the pharmacological approach of blocking the proton pump. The endoscopical techniques of adrenaline injection fibrin-'glue' injection, polidocanol injection and heat coagulation can stop active bleeding in over 90% of cases. Pharmacologically, proton pump inhibitors can quickly achieve the optimal pH condition for support of the physiological cascade of haemostasis. The aim is to keep the intragastric pH above 6.0 for a few days. For the first time this aim can be achieved quickly and reliably by infusion of proton pump inhibitors. The optimal form of application is continuous infusion. Repeated bolus injections do not give optimal results. The optimal dosing was found to be the continuous infusion of 8 mg/h omeprazole or pantoprazole after an initial loading dose of 40-80 mg.
几年前，如果消化性溃疡出血不止，患者就会被转介给外科医生。如今，我们有两种很有前景的新方法来避免急诊手术。一种是内镜干预，另一种是阻断质子泵的药物治疗方法。肾上腺素注射、纤维蛋白“胶水”注射、聚多卡醇注射和热凝等内镜技术能在90%以上的病例中止住活动性出血。在药理学上，质子泵抑制剂能迅速达到支持生理性止血级联反应的最佳pH条件。目标是使胃内pH值在几天内保持在6.0以上。首次通过输注质子泵抑制剂可快速可靠地实现这一目标。最佳的给药方式是持续输注。重复推注给药不能获得最佳效果。发现最佳剂量是在初始负荷剂量40 - 80毫克后，持续输注8毫克/小时的奥美拉唑或泮托拉唑。
