【摘要】 目的 探讨大剂量雷贝拉唑针剂治疗急性重症颅脑损伤合并上消化道出血的临床效果。方法 选取2015年6月至2016年12月福建医科大学附属第二医院收治的急性重症颅脑损伤合并上消化道出血患者42例。根据随机数字表法,将患者分为对照组和观察组,各21例。观察组给予静脉滴注大剂量雷贝拉唑钠针剂治疗;对照组给予静脉滴注常规剂量雷贝拉唑治疗;2组均连续给药5 d。比较2组患者给药后4、12、24 h的胃液pH值,给药后24、48 h血常规及生化指标情况,治疗效果和不良反应发生情况。结果 观察组给药后4、12、24 h胃液pH值均高于对照组[(4.08±0.15)比(3.15±0.27)、(5.66±0.45)比(3.67±0.51)、(6.04±0.31)比(5.16±0.34)],差异均有统计学意义(均P<0.05);给药后24、48 h血红蛋白与血浆碳酸氢根离子水平高于、尿素氮水平低于对照组[(118±13)g/L比(87±12)g/L、(123±10)g/L比(109±11)g/L;(16.0±1.3)mmol/L比(15.0±4.2)mmol/L、(24.0±0.9)mmol/L比(20.0±1.2)mmol/L;(6.6±3.7)mmol/L比(8.8±4.6)mmol/L、(4.9±2.3)mmol/L比(6.8±1.5)mmol/L],差异均有统计学意义(均P<0.05)。观察组总有效率高于对照组[95.2%(20/21)比81.0%(17/21)],差异有统计学意义(P<0.05)。观察组不良反应发生率与对照组比较,差异无统计学意义(P>0.05)。结论 大剂量雷贝拉唑针剂的抑酸效果更强,止血效果优于常规剂量雷贝拉唑,安全性良好。更多还原

【Abstract】 Objective To investigate the clinical effect of high dose rabeprazole on acute severe craniocerebral injury complicated with upper gastrointestinal hemorrhage. Methods Forty-two patients with acute severe craniocerebral injury complicated with upper gastrointestinal hemorrhage from June 2015 to December 2016 in Fujian Medical University 2 nd Affiliated Hospital were randomly divided into control group and observation group,with 21 cases in each group. The observation group was treated by intravenous drip of high dose of rabeprazole; the control group had routine dose of intravenous rabeprazole; both groups were treated for 5 d. Gastric juice pH value was tested 4, 12, 24 h after treatment; blood routine and biochemical indicators were tested 24, 48 h after treatment; clinical efficacy and adverse reactions were analyzed. Results The 4, 12, 24 h gastric juice pH values in observation group were significantly higher than those in control group [（4. 08 ± 0. 15） vs（3. 15 ± 0. 27）,（5. 66 ±0.45） vs（3. 67 ±0.51）,（6. 04 ±0.31） vs（5. 16 ±0.34）]（P <0.05）. The 24, 48 h levels of hemoglobin and plasma HCO₃^-in observation group were significantly higher and the level of urea nitrogen was significantly lower than those in control group[（118 ± 13） g/L vs（87 ± 12） g/L,（123 ± 10） g/L vs（109 ±11） g/L;（16. 0 ± 1. 3） mmol/L vs（15. 0 ± 4. 2） mmol/L,（24. 0 ± 0. 9） mmol/L vs（20. 0 ± 1. 2） mmol/L;（6. 6 ±3. 7） mmol/L vs（8. 8 ± 4. 6） mmol/L,（ 4. 9 ± 2. 3） mmol/L vs（6. 8 ± 1. 5） mmol/L]（ < 0. 05）. The total effective rate in observation group was significantly higher than that in control group [95. 2%（20/21） vs 81. 0%（17/21） ]（ P < 0. 05）. The adverse reaction rate had no significant difference between groups（ P > 0. 05）.Conclusion High dose of intravenous rabeprazole shows acid-suppressive and hemostatic effects on craniocerebral injury patients with upper gastrointestinal bleeding without increasing adverse effects.更多还原