目的:探讨胃内局部调节胃液酸碱度在预防重型颅脑损伤应激性溃疡出血中的作用。方法:将120例重型颅脑损伤患者采用随机数字表法随机分为试验组和对照组。每组60例,实验组测定胃液pH值;根据pH值结果给予干预措施,对照组常规使用质子泵抑制剂预防。结果:两组患者应激性溃疡出血发生率比较差异无统计学意义(P > 0.05),试验组较对照组相关医疗费用明显降低,差异有统计学意义(P < 0.05)。结论:早期监测胃液pH值,根据pH值的变化及早采取预防措施,有早期预防治疗的作用,能显著降低医疗费用。 Objective: To investigate the effect of local adjustment of gastric acidity and alkalinity in preventing stress ulcer bleeding caused by severe craniocerebral injury. Methods: 120 patients with severe craniocerebral injury were randomly divided into experimental group and control group. There were 60 cases in each group. The pH value of gastric juice was measured in the experimental group and interventions were given according to the pH results. The control group routinely received proton pump inhibitors. Results: There was no significant difference in the incidence of stress ulcer bleeding between the two groups (P > 0.05). Compared with the control group, the related medical expenses of the experimental group were significantly lower, and the difference was statistically significant (P < 0.05). Conclusion: Early monitoring of gastric pH value and taking preventive measures according to the change of pH value can have the effect of early prevention and significantly reduce medical costs.
目的:探讨胃内局部调节胃液酸碱度在预防重型颅脑损伤应激性溃疡出血中的作用。方法:将120例重型颅脑损伤患者采用随机数字表法随机分为试验组和对照组。每组60例,实验组测定胃液pH值;根据pH值结果给予干预措施,对照组常规使用质子泵抑制剂预防。结果:两组患者应激性溃疡出血发生率比较差异无统计学意义(P > 0.05),试验组较对照组相关医疗费用明显降低,差异有统计学意义(P < 0.05)。结论:早期监测胃液pH值,根据pH值的变化及早采取预防措施,有早期预防治疗的作用,能显著降低医疗费用。
胃液酸碱度,重型颅脑损伤,应激性溃疡出血,干预
Zhaozhen Hou1, Zhenwen Xue2
1People’s Hospital of Bayingolin Mongolian Autonomous Prefecture, Korla Xinjiang
2The First People’s Hospital of Korla, Korla Xinjiang
Received: Mar. 8th, 2022; accepted: Mar. 31st, 2022; published: Apr. 12th, 2022
Objective: To investigate the effect of local adjustment of gastric acidity and alkalinity in preventing stress ulcer bleeding caused by severe craniocerebral injury. Methods: 120 patients with severe craniocerebral injury were randomly divided into experimental group and control group. There were 60 cases in each group. The pH value of gastric juice was measured in the experimental group and interventions were given according to the pH results. The control group routinely received proton pump inhibitors. Results: There was no significant difference in the incidence of stress ulcer bleeding between the two groups (P > 0.05). Compared with the control group, the related medical expenses of the experimental group were significantly lower, and the difference was statistically significant (P < 0.05). Conclusion: Early monitoring of gastric pH value and taking preventive measures according to the change of pH value can have the effect of early prevention and significantly reduce medical costs.
Keywords:pH of Gastric Juice, Severe Craniocerebral Injury, Stress Ulcer Bleeding, Intervention
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应激性溃疡致消化道出血是重型颅脑损伤患者最常见的早期并发症之一 [
① 符合重型颅脑损伤的诊断标准;② 年龄 ≥ 18岁且≤75岁;③ 格拉斯哥评分GCS < 8分的患者;④ 伤前无应激性溃疡出血,既往无消化性溃疡、出血性疾病病史;⑤ 生存期 ≥ 10 d;⑥ 家属理解并愿意参加本临床研究并签署知情同意书;⑦ 入院时间均在6 h内进行随机分组。
采用同期随机对照分组分析研究,收集在巴州人民医院神经外科、库尔勒市第一人民医院神经外科重型颅脑损伤患者采用随机数字表法随机分为试验组(胃内局部应用5%碳酸氢钠调节胃液的酸碱度)和对照组(常规静脉应用泮托拉唑)。计算两组样本量不少于120例,平均每组不少于60例。
1) 试验组:入院后即刻置胃管,在置胃管即刻、2 h、4 h三个点分别测定胃液pH值,连续测得3次pH值的平均值计为患者的pH值,当患者胃液pH值 < 4.0时,预防性地给予5%碳酸氢钠50 mL胃内注入,注入速度为30 mL/min,留置5 min后待药物与胃液充分混合后予等量抽出,同时开放胃管引流,并随时观察胃液的性状,颜色。洗胃后2 h再次测定胃液pH值,评判洗胃效果。如pH值仍<4.0,重复上述步骤,直到pH值 ≥ 4.0以上为止。若pH ≥ 4.0者,不用任何药物干预。一周内每日10:00、16:00、21:00注射器抽吸胃液5 mL,观察性状,以pH试纸检测酸碱度,每日行一次潜血检查,一旦发生出血,立即停止胃液pH值监测及干预,按照应激性消化道溃疡出血的指南治疗。
2) 对照组:入院后一周内每日一次泮托拉唑80 mg + 0.9%氯化钠注射液100 mL静脉滴注30 min,鼻饲前负压抽吸胃液,观察性状,并每日行一次潜血检查,一旦发生出血,按照应激性消化道溃疡出血的指南治疗。
采用SPSS22.0统计学软件进行数据分析,计量资料用均数 ± 标准差( X ¯ ± S )表示,比较采用t检验;计数资料以率(%)表示,组间比较采用字x2检验。P < 0.05为差异有统计学意义。
1) 胃液pH值的测定方法:患者鼻饲置胃管后以20 mL注射器抽取胃液4 mL~5 mL,前1 mL弃去,以除外鼻胃管无效腔pH值。测定选用上海三爱斯试剂有限公司的pH精密试纸,初测选用测试范围1~14的试纸(最小单位为1),大概测定范围之后,选用测试范围在0.5~5.0或5.4~7.0试纸(最小单位为0.4)复测,以确定最终的pH值。
2) 胃液潜血检查:送检验科检测。
两组患者应激性溃疡的发生率和相关医疗费用比较,详见表1。
组别 | 应激性溃疡出血例(%) | 相关医疗费用(元) |
---|---|---|
试验组(n = 60) | 15 (25.00)* | 112 ± 16# |
对照组(n = 60) | 14 (23.33) | 782 ± 21 |
表1. 两组患者应激性溃疡的发生率和相关医疗费用比较
*与对照组比较,P > 0.05;#与对照组比较,P < 0.05。
1) 应激性溃疡出血严重影响患者预后,甚至危及生命,积极处理颅脑创伤导致的颅内和全身性病理生理改变,减少导致应激性溃疡的危险因素,有效降低应激反应是防治颅脑创伤后应激性溃疡的最基本和最重要的方法。同时,科学合理地预防措施,可以有效降低应激性溃疡出血的发生率,提高患者的预后及生活质量。
2) 现有研究认为其发病机制可归纳为以下几点:a) 颅脑损伤后机体处于应激状态,致交感肾上腺系统激活,交感神经强烈兴奋,体内儿茶酚胺类分泌明显增多,致胃黏膜血管强烈持续收缩,致使黏膜损伤 [
3) 临床中,早期发现及及时治疗是重型颅脑损伤后应激性溃疡出血防治的关键。通过本实验的研究表明,胃液pH值在1到4之间波动时。早期进行胃液pH值干预,直到胃液pH值升至4以上,可以起到有效的预警作用,指导应激性溃疡治疗的起止。试验组较对照组患者应激性溃疡出血发生率差异无统计学意义(P > 0.05),并且无大量出血病例的发生,说明此方法在治疗应激性溃疡方面安全有效。试验组较对照组相关医疗费用明显降低,差异有统计学意义(P < 0.05)。做到有的放矢,避免盲目性预防用药,可以明显减少患者的经济负担。
综上所述,此法操作简便,临床运行成本低,能够很好地应用于临床,在改善预后及降低医疗费用方面具有重要的作用,适于临床推广应用。
本研究获巴州人民医院院级科研项目《胃内局部调节胃液酸碱度(pH值)对预防重型颅脑损伤患者应激性溃疡出血的研究》基金支持,项目编号:BY202026。
本研究已获得病人知情同意。
侯召振,薛振文. 调节胃液酸碱度在预防重型颅脑损伤应激性溃疡出血中的作用 The Effect of Adjustment of Gastric Acidity and Alkalinity in Preventing Stress Ulcer Bleeding Caused by Severe Craniocerebral Injury[J]. 临床医学进展, 2022, 12(04): 2605-2608. https://doi.org/10.12677/ACM.2022.124374