摘要
目的 了解胃酸抑制与小儿消化性溃疡愈合的关系 ,寻求最适抑酸度。方法 将消化性溃疡患儿 2 7例随机分成两组 ,分别用雷尼替丁 (A组 )和奥美拉唑 (B组 )口服治疗 4～ 6周 (平均 5周 ) ,监测治疗前和给药第 1天、第 1及 5周时的胃pH变化 ,并复查胃镜 ,评价溃疡愈合情况。结果A组 16例中 6例未愈合 ,10例愈合 ,B组 11例全部愈合。抗酸治疗后两组患儿胃pH值均升高 ,A组胃pH平均值、pH平均中位数及pH >3时间百分比在给药第 1和 5周均比第 1天降低 ,药效维持时间也缩短 ,差异有显著性。B组胃pH平均值、pH平均中位数在给药第 1和 5周均比第 1天增加 ,药效维持时间也延长 ,差异有显著性。A组治愈者在给药第 5周时胃pH平均值、pH平均中位数、pH >3时间百分比、药效维持时间均大于未治愈者 ,差异有显著性。A组未治愈者在治疗过程中抑酸效能逐渐下降 ,差异有显著性。结论 雷尼替丁产生的耐受性会影响溃疡的愈合。在 4、5周的抗酸治疗中每天给药后能使胃pH维持在 3以上持续 5～
Objective It is well known that the suppression of gastric acidity is one of the most essential factors in promoting healing and preventing relapse of peptic ulcers. Little is known, however, about how to inhibit gastric acid secretion effectively in children with peptic ulcers. The present study aimed at understanding the optimal acid suppression by examining the relationship between ulcer healing and the suppression of gastric acid in children. Methods Patients with peptic ulcers diagnosed by endoscopy were randomized to receive either oral ranitidine (group A) or oral omeprazole (group B) for 4 6 weeks (mean 5 weeks). Intragastric 24 hour pH monitoring was performed before treatment, and repeated three times: on day 1, weeks 1 and 5 post dosing. Endoscopy was repeated on week 5 to evaluate the healing condition of ulcers. Results Twenty seven patients followed up by endoscopy and pH monitoring were eligible for final analysis. The ulcers in 16 patients of group A and in all (11 cases) of group B were healed. No significant differences in the gastric mean pH, median pH and percentage of time with gastric pH>3 between the two groups were observed before treatment. Gastric pH increased significantly after treatment in both groups. These parameters in group A decreased significantly during weeks 1 and 5 as compared to those on day 1 post dosing; the duration of drug action was also shortened significantly. The gastric mean pH and mean median pH in group B were significantly higher during weeks 1 and 5 than on day 1 of post dosing, the duration of drug action was also prolonged significantly. According to the result of endoscopic re examination, the authors subdivided group A into unhealed (group C) and healed (group D) groups. The gastric acid suppressive effect in group C attenuated significantly by the end of the 5 week treatment and the differences of gastric mean pH and median pH, percentage of time with pH>3 between week 5 and pre treatment level were not significant. While these parameters in group D were still significantly higher during week 5 than those obtained before treatment. The gastric mean pH and median pH, percentage of time with pH>3 and the duration of drug action during week 5 were significantly higher in group D than in group C. The mean shortest duration of drug action in group B was 10 h, while it was 5 h in group D. Conclusions The onset of tolerance to ranitidine during the therapy might have affected healing of ulcers in the subjects. The optimal acid suppression for healing ulcers in children could be regarded as maintaining the gastric pH>3 for 5 10 hours a day of post dosing during 4 6 weeks of anti secretory treatment.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2000年第9期540-543,共4页
Chinese Journal of Pediatrics
关键词
消化性溃疡
氢离子浓度
儿童
药物耐受性
抑酸度
Peptic ulcer
Hydrogen ion concentration
Ranitidine
Omeprazole
Drug tolerance
