【摘要】 目的　了解夜间酸突破现象 (NAB)并寻求解决措施。方法　胃镜确诊十二指肠球部溃疡(DU)病人 4 0例 ,随机分为 5组 ,每组 8例 ,治疗方法 :A组奥美拉唑 2 0mg ,每日 1次口服 (晨起 ) ,B组奥美拉唑 2 0mg ,每日 2次口服 (晨起及下午 4时 ) ,C组奥美拉唑 4 0mg ,每日 2次静脉注射 (晨起及下午 4时 ) ,D组奥美拉唑 2 0mg ,每日 1次口服 (晨起 ) +雷尼替丁 15 0mg临睡前服 ,E组奥美拉唑 2 0mg ,每日2次口服 (晨起及下午 4时 ) +雷尼替丁 15 0mg临睡前服。所有病人于用药治疗第 5天连续 2 4h监测胃内pH值。结果　与A组 (4.8± 0 .7,4 .7± 0 .8)相比 ,后 4组病人的平均胃内pH值、夜间平均胃内pH值显著升高 ,B组为 6 .2± 0 .7,6 .4± 1.1;C组为 6 .9± 0 .7,6 .8± 0 .9;D组为 6 .0± 0 .7,5 .9± 0 .7;E组为 5 .8± 0 .5 ,6 .1± 0 .5 ,差异均有显著性 (P <0 .0 5 )。夜间 pH <4 .0的时间百分比A组 (2 8.4± 2 9.6 )较B组 (1.5± 1.9)、C组 (1.2± 1.3)、D组 (0 .1± 0 .3)、E组 (2 .9± 5 .1)明显增高 (P <0 .0 5 )。NAB发生情况A组 5例 ,较B组 1例 ,C组 0例 ,D组 2例 ,E组 0例明显增多 (P <0 .0 5 )。幽门螺杆菌 (Hp)阴性的病人NAB发生率显著高于阳性病人。结论　DU病人 ,NAB的发生与奥美拉唑的用药剂量、用更多还原

【Abstract】 Objective To assess the incidence and management of nocturnal acid breakthrough (NAB). Methods Forty patients with duodenal ulcer confirmed by gastroscopy were randomly divided into five groups, eight patients in each group. Patients were treated by the following strategies for a course of 5 days: group A (omeprazole 20 mg per day orally in the morning), group B (omeprazole 20 mg twice a day orally in the morning and at 4 p.m), group C (intravenous injection of omeprazole 40 mg twice a day in the morning and at 4 p.m), group D (omeprazole 20 mg per day orally in the morning plus ranitidine 150 mg at bed time) and group E (omeprazole 20 mg twice a day orally in the morming and at 4 p.m plus ranitidine 150 mg at bed time) respectively. Intragastric pH over 24 hours was recorded on the morning of the fifth day for each patient. Results In comparison with that in group A, intragastric pH was higher in the other four groups. The mean intragastric pH and mean nocturnal pH each in group B (6.2±0.7, 6.4±1.1), group C (6.9±0.7, 6.8±0.9), group D (6.0±0.7, 5.9±0.7) and group E (5.8±0.5, 6.1±0.5) were significantly higher than those in group A (4.8±0.7, 4.7±0.8, P <0.05). The percentage of fraction time of pH below 4.0 in group A (28.4±29.6) was much higher than that in group B (1.5±1.9), group C (1.2±1.3), group D (0.1±0.3) and group E (2.9±5.1, P <0.05). The incidence of NAB in group A (5/8) was significantly higher than that in the other four groups ( P <0.05). The incidence of NAB in Helicobacter pylori(H. pylori ) negative patients (46.1%) was significantly higher than that in H. pylori positive (14.8%) patients( P <0.05). Conclusion The prevalence of NAB is closely related to the dosage of and approach to the administration of omeprazole. The regimen of both ranitidine and omeprazole can decrease the prevalence of NAB. The presence of H.pylori infection also appears to be closely related to the prevalence of NAB.更多还原