2020 年第 4 期 第 15 卷

奥美拉唑联合酚磺乙胺治疗急性上消化道出血的效果及对患者免疫功能的影响

Clinical effect of omeprazole combined with etamsylate on acute upper gastrointestinal bleeding and immune function

作者：王卉马剡芳

英文作者：Wang Hui Ma Yanfang

单位：首都医科大学附属北京地坛医院急诊科100015

英文单位：Department of Emergency Beijing Ditan Hospital Capital Medical University Beijing 100015 China

关键词：急性上消化道出血；奥美拉唑；酚磺乙胺；免疫功能

英文关键词：Acuteuppergastrointestinalbleeding；Omeprazole；Etamsylate；Immunefunction

• 摘要：

• 【摘要】目的    探究奥美拉唑联合酚磺乙胺治疗急性上消化道出血的效果及对患者免疫功能的影响。方法    选取2017年2月至2018年2月于首都医科大学附属北京地坛医院接受治疗的急性上消化道出血患者120例，按照随机数字表法分为酚磺乙胺组和联合治疗组，各60例。酚磺乙胺组患者使用酚磺乙胺注射液进行治疗；联合治疗组患者使用奥美拉唑注射液联合酚磺乙胺注射液进行治疗。比较2组患者止血、血压稳定以及腹痛缓解时间，治疗前后H+-K+-ATP酶活性、纤维蛋白稳定因子（FSF）、纤维蛋白原（FIB）水平,血小板功能以及T淋巴细胞亚群水平，比较2组患者治疗效果及不良反应发生情况。结果    联合治疗组患者止血、血压稳定以及腹痛缓解时间均短于酚磺乙胺组［（1.13±0.22）d比（1.61±0.29）d、（6.7±2.0）d比（9.9±2.0）d、（1.3±0.3）d比（2.6±0.4）d］，差异均有统计学意义（均P＜0.001）。治疗后，联合治疗组H+-K+-ATP酶活性低于酚磺乙胺组，FSF、FIB、血小板分布宽度、平均血小板体积、血小板计数、血小板聚集率水平高于酚磺乙胺组（均P＜0.05）。治疗后，联合治疗组患者CD+3、CD+4水平高于酚磺乙胺组，CD+8水平低于酚磺乙胺组（均P＜0.05）。联合治疗组患者治疗总有效率高于酚磺乙胺组［96.7%（58/60）比83.3%（50/60）］（P=0.015）,不良反应发生率与酚磺乙胺组比较差异无统计学意义（P=0.343）。结论    奥美拉唑联合酚磺乙胺对急性上消化道出血患者进行治疗，能够抑制H+-K+-ATP酶活性，激活FSF，促进FIB表达，促进凝血，改善血小板功能以及免疫功能，治疗效果显著。

• 【Abstract】Objective    To explore the clinical efficacy of omeprazole combined with etamsylate in treatment of acute upper gastrointestinal bleeding and the effect on immune function.MethodsFrom February 2017 to February 2018, 120 patients with acute upper gastrointestinal bleeding who were treated by Beijing Ditan Hospital, Capital Medical University were randomly assigned to etamsylate injection（n=60） and omeprazole plus etamsylate injection（n=60）. Hemostasis effect, blood pressure fluctuation and abdominal pain relief time were observed. H+-K+-ATPase activity, fibrin stabilizing factor(FSF), fibrinogen(FIB), platelet function and T lymphocyte subsets were detected. Clinical therapeutic effect and incidence of adverse reactions were analyzed. Results    Omeprazole combined with etamsylate showed faster effects on hemostasis, blood pressure stabilization and abdominal pain relief than etamsylate alone［（1.13±0.22）d vs （1.61±0.29）d, （6.7±2.0）d vs （9.9±2.0）d, （1.3±0.3）d vs （2.6±0.4）d］(all P＜0.001). After treatment, activity of H+-K+-ATPase with omeprazole plus etamsylate treatment was lower and levels of FSF, FIB, platelet count, average platelet volume, platelet distribution width and platelet aggregation rate were higher than those with etamsylate(all P＜0.05). After treatment, levels of CD+3 and CD+4 with omeprazole plus etamsylate treatment were higher and CD+8 level was lower than with etamsylate(all P＜0.05). Total effective rate of omeprazole combined with etamsylate was significantly higher than that of etamsylate［96.7%（58/60） vs 83.3%（50/60）］(P=0.015). Incidence of adverse reactions showed no significant difference(P=0.343). Conclusion    Omeprazole combined with etamsylate treating acute upper gastrointestinal hemorrhage can effectively inhibit H+-K+-ATPase activity, activate FSF and FIB, and improve coagulation, platelet function and immune function.