Lin H J, Lo W C, Perng C L, Wang K, Lee F Y
Department of Medicine, Veterans General Hospital-Taipei, Taiwan.
Hepatogastroenterology. 1997 Sep-Oct;44(17):1495-9.
BACKGROUND/AIMS: The hypothesis that profound acid suppression might prevent clot lysis and thus benefit patients with a non-bleeding visible vessel has not been confirmed. Omeprazole can suppress gastric acid remarkably and may be beneficial for patients with peptic ulcer bleeding.
Fifty-two patients with a non-bleeding visible vessel at the ulcer base were enrolled and randomized into four groups (N = 13 in each group). In the cimetidine group, the patients received cimetidine 300 mg i.v. bolus followed by 300 mg i.v. every 6 hr during hospitalization. In the heater probe thermocoagulation + cimetidine group, the patients received heater probe thermocoagulation and cimetidine 300 mg i.v. bolus followed by 300 mg i.v. every 6 h during hospitalization. In the omeprazole q.d. group, the patients received omeprazole 40 mg i.v. bolus followed by 40 mg i.v. daily for two days. In the omeprazole q 12 h group, the patients received omeprazole 40 mg i.v. bolus followed by 40 mg i.v. every 12 h for two days. A 24 hr intragastric pH was recorded for every case.
The mean 24 hr intragastric pH were higher in the omeprazole q.d. (mean 5.8) and the omeprazole q 12 h groups (mean 6.4) than in the cimetidine (mean 4.3) and the heater probe thermocoagulation + cimetidine groups (mean 4.9) (p < 0.05). Rebleeding occurred in 5, 2, 2 and 2 patients in the cimetidine, heater probe thermocoagulation + cimetidine, omeprazole q.d., and omeprazole q 12 h groups, respectively (p > 0.05). Volume of blood transfusion and number of days in hospital were not statistically different among the four groups.
Omeprazole can remarkably suppress gastric acid when it is compared to that of the H2 receptor blocker. Patients with a non-bleeding visible vessel using omeprazole do not exhibit a decrease in the rebleeding rate as compared with those patients using cimetidine.
背景/目的：深度抑酸可能会阻止血凝块溶解，从而使有非出血性可见血管的患者受益，这一假说尚未得到证实。奥美拉唑能显著抑制胃酸，可能对消化性溃疡出血患者有益。
纳入52例溃疡底部有非出血性可见血管的患者，随机分为四组（每组13例）。西咪替丁组患者静脉推注西咪替丁300mg，住院期间每6小时静脉注射300mg。热探头热凝+西咪替丁组患者接受热探头热凝治疗，并静脉推注西咪替丁300mg，住院期间每6小时静脉注射300mg。奥美拉唑每日一次组患者静脉推注奥美拉唑40mg，随后连续两天每日静脉注射40mg。奥美拉唑每12小时一次组患者静脉推注奥美拉唑40mg，随后连续两天每12小时静脉注射40mg。记录每例患者24小时胃内pH值。
奥美拉唑每日一次组（平均5.8）和奥美拉唑每12小时一次组（平均6.4）的平均24小时胃内pH值高于西咪替丁组（平均4.3）和热探头热凝+西咪替丁组（平均4.9）（p<0.05）。西咪替丁组、热探头热凝+西咪替丁组、奥美拉唑每日一次组和奥美拉唑每12小时一次组分别有5例、2例、2例和2例患者发生再出血（p>0.05）。四组间输血量和住院天数无统计学差异。
与H2受体阻滞剂相比，奥美拉唑能显著抑制胃酸。使用奥美拉唑的有非出血性可见血管的患者与使用西咪替丁的患者相比，再出血率并未降低。
