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目的 探讨溃疡出血的易患因素及防治措施。方法 选择近 5年我院接受 2 4h胃pH监测并行胃镜检查确诊为消化性溃疡的病例 96例 ,其中出血组 43例 ,非出血组 5 3例。幽门螺旋杆菌 (Hp)感染由快速尿素酶实验、病理学及C13 呼吸实验诊断。比较两组 2 4h胃pH监测结果、Hp感染率等。采用SPSS软件非参数检验等进行统计学分析。结果 消化性溃疡出血组平卧位平均胃pH值 1 60 ,较对照组 1 90为低 (P =0 0 3 3 ) ;且出血组平卧位胃pH在 0 -1的累积时间百分比中位数为 2 1 0 % ,平卧位胃pH在0 -1最长持续时间中位数 2 6 0min ,均明显长于非出血组 2 0 %和 4 5min(P =0 0 0 8,0 0 19)。但是 ,大出血病例相比其他出血病例胃pH水平无差别 ( P >0 0 5 )。出血组与非出血组Hp感染率分别为 5 6 1% ,5 4 8% ,无统计学差别 ( P >0 0 5 )。结论 溃疡出血存在多种致病因素。夜间胃酸分泌过高 ,特别是pH在 0 -1的酸暴露时间过长是消化性溃疡出血的危险因素之一 ,提示溃疡病患者睡前给予抑酸剂治疗可有效预防溃疡出血。Hp菌感染并非溃疡出血的直接危险因素。
Objective To investigate the predisposing factors and prevention measures of ulcer bleeding. Methods In the recent 5 years, our hospital received 24 hours gastric pH monitoring and gastroscopy diagnosed as peptic ulcer in 96 cases, of which 43 cases of bleeding, non-bleeding group of 53 cases. Helicobacter pylori (Hp) infection is diagnosed by rapid urease test, pathology and C13 respiration test. 24 h gastric pH monitoring results, Hp infection rate and other two groups were compared. Using SPSS software non-parametric test for statistical analysis. Results The peptic ulcer bleeding group supine average stomach pH value of 1 60, compared with the control group of 90 low (P = 0 0 3 3); and bleeding group supine position stomach pH in the cumulative percentage of time 0 -1 median The number was 210%, and the median pH value of supine position was the longest duration of 0-1, which was significantly longer than that of non-hemorrhagic group (20%, 45 min, P = 0.080, 0.019 ). However, there was no difference in the gastric pH levels among the bleeding cases compared with other bleeding cases (P> 0.05). The infection rates of Hp in bleeding and non-bleeding groups were 56.1% and 54.8% respectively, with no significant difference (P> 0.05). Conclusion There are many pathogenic factors of ulcer bleeding. Acid secretion at night is too high, especially at pH 0 -1 acid exposure time is one of the risk factors for peptic ulcer bleeding, suggesting that patients with ulcer before bedtime administration of acid suppression can effectively prevent ulcer bleeding. Hp infection is not a direct risk factor for ulcer bleeding.