Artal A, Lanas A, Barrao M E, Moliner F J, Blas J M, López J
Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza.
Rev Esp Enferm Dig. 1996 Mar;88(3):191-6.
The pharmacotherapy of bleeding peptic ulcer is directed to improve the environment of the bleeding point by keeping the gastric pH above the proteolytic range for pepsin.
To evaluate the best pharmacological approach to inhibit gastric acid secretion with current antisecretory drugs in patients with bleeding duodenal ulcers.
Forty-seven patients with bleeding duodenal ulcers were randomized to receive I.V.: I) Omeprazole: an initial bolus of 80 mg + perfusion of 3.3 mg/h; II) Omeprazole: an initial bolus of 80 mg + 40 mg/12 h; III) Omeprazole: 40 mg/8 h; IV) Ranitidine: perfusion of 12.5 mg/h; V) Ranitidine: 50 mg/4 h. Gastric acidity was measured and recorded by 24 h gastric pH monitoring.
All types of treatment with omeprazole were superior to either continuous perfusion or intermittent bolus of ranitidine in increasing the pH for 24 h and reducing the % of time the gastric pH was below 4 and 6, and the number of time the gastric pH was below 4 for more than 5 min. There were no statistical differences between the different regimens of omeprazole, but continuous perfusion of ranitidine was superior to intermittent ranitidine bolus.
Parenteral omeprazole is better than parenteral ranitidine in keeping the intragastric pH above the proteolytic range for pepsin in patients with bleeding duodenal ulcers.
消化性溃疡出血的药物治疗旨在通过使胃内pH值保持在胃蛋白酶的蛋白水解范围之上，来改善出血点的环境。
评估使用当前的抑酸药物抑制十二指肠溃疡出血患者胃酸分泌的最佳药理学方法。
47例十二指肠溃疡出血患者被随机分为静脉注射组：I）奥美拉唑：初始推注80mg + 以3.3mg/h的速度灌注；II）奥美拉唑：初始推注80mg + 每12小时40mg；III）奥美拉唑：每8小时40mg；IV）雷尼替丁：以12.5mg/h的速度灌注；V）雷尼替丁：每4小时50mg。通过24小时胃pH监测来测量和记录胃酸度。
在提高24小时pH值、降低胃pH值低于4和6的时间百分比以及胃pH值低于4超过5分钟的次数方面，所有类型的奥美拉唑治疗均优于雷尼替丁的持续灌注或间歇推注。不同奥美拉唑方案之间无统计学差异，但雷尼替丁的持续灌注优于雷尼替丁间歇推注。
在十二指肠溃疡出血患者中，静脉注射奥美拉唑在使胃内pH值保持在胃蛋白酶的蛋白水解范围之上方面优于静脉注射雷尼替丁。
