Title:Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding

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Title:Omeprazole before Endoscopy in Patients with Gastrointestinal Bleeding
题目：消化道出血患者在内镜检查前奥美拉唑的应用
Author作者:James Y. Lau, M.D., Wai K. Leung, M.D., Justin C.Y. Wu, M.D., et al
Resource:The New England Journal of Medicine ,2007,Volume 356:1631-1640
来源：新英格兰药学杂志，2007，卷 356:1631-1640
ABSTRACT 摘要
Background: A neutral gastric pH is critical for the stability of clots over bleeding arteries. We investigated the effect of preemptive infusion of omeprazole before endoscopy on the need for endoscopic therapy.
背景资料：中性胃PH值对覆盖于出血动脉之上的凝血块的稳定性是极端不利的。我们调查了对于需要内镜治疗的病人在内镜检查前预先应用奥美拉唑的效果。
Methods: Consecutive patients admitted with upper gastrointestinal bleeding underwent stabilization and were then randomly assigned to receive either omeprazole or placebo (each as an 80-mg intravenous bolus followed by an 8-mg infusion per hour) before endoscopy the next morning.
方法：确诊上消化道出血的连续性病例被随机分配接受奥美拉唑或安慰剂治疗（首剂给予80-mg静脉推注，随后持续静脉滴注8-mg/小时），然后在第2天早晨行内镜检查。
Results: Over a 17-month period, 638 patients were enrolled and randomly assigned to omeprazole or placebo (319 in each group). The need for endoscopic treatment was lower in the omeprazole group than in the placebo group (60 of the 314 patients included in the analysis [19.1%] vs. 90 of 317 patients [28.4%], P=0.007). There were no significant differences between the omeprazole group and the placebo group in the mean amount of blood transfused (1.54 and 1.88 units, respectively; P=0.12) or the number of patients who had recurrent bleeding (11 and 8, P=0.49), who underwent emergency surgery (3 and 4, P=1.00), or who died within 30 days (8 and 7, P=0.78). The hospital stay was less than 3 days in 60.5% of patients in the omeprazole group, as compared with 49.2% in the placebo group (P=0.005). On endoscopy, fewer patients in the omeprazole group had actively bleeding ulcers (12 of 187, vs. 28 of 190 in the placebo group; P=0.01) and more omeprazole-treated patients had ulcers with clean bases (120 vs. 90, P=0.001).
结果：在超过17个月的试验过程中，共有638名患者参加随机接受奥美拉唑或安慰剂治疗（319例/组）。奥美拉唑治疗组中需要进行内镜治疗的患者低于安慰剂组（分别为314例患者中占60例[19.1%]与90/317[28.4%], P=0.007）。奥美拉唑治疗组和安慰剂组在平均输血量(1.54 和 1.88 单位; P=0.12)、复发出血患者数量(11 和 8, P=0.49)、急诊手术患者数量(3 和 4, P=1.00)以及30天内死亡率(8 和 7, P=0.78)没有显著差异。奥美拉唑治疗组中住院期小于3天的患者占60.5%，而安慰剂组占49.2%(P=0.005)。在内镜检查时，奥美拉唑治疗组比安慰剂组中有活动性出血性溃疡的患者少(12 /187, vs. 28 / 190; P=0.01),而有清洁基地部溃疡的患者多(120 vs. 90, P=0.001)。
Conclusions: Infusion of high-dose omeprazole before endoscopy accelerated the resolution of signs of bleeding in ulcers and reduced the need for endoscopic therapy. (ClinicalTrials.gov number, NCT00164866 [ClinicalTrials.gov] .)
结论：内镜检查前静脉滴注高剂量奥美拉唑促进溃疡出血消除并减少内镜治疗的必须性。

题目：消化道出血患者在内镜检查前奥美拉唑的应用

来源：新英格兰药学杂志，2007，卷 356:1631-1640

背景资料：中性胃PH值对覆盖于出血动脉之上的凝血块的稳定性是极端不利的。我们调查了对于需要内镜治疗的病人在内镜检查前预先应用奥美拉唑的效果。

方法：确诊上消化道出血的连续性病例被随机分配接受奥美拉唑或安慰剂治疗（首剂给予80-mg静脉推注，随后持续静脉滴注8-mg/小时），然后在第2天早晨行内镜检查。

结果：在超过17个月的试验过程中，共有638名患者参加随机接受奥美拉唑或安慰剂治疗（319例/组）。奥美拉唑治疗组中需要进行内镜治疗的患者低于安慰剂组（分别为314例患者中占60例[19.1%]与90/317[28.4%], P=0.007）。奥美拉唑治疗组和安慰剂组在平均输血量(1.54 和 1.88 单位; P=0.12)、复发出血患者数量(11 和 8, P=0.49)、急诊手术患者数量(3 和 4, P=1.00)以及30天内死亡率(8 和 7, P=0.78)没有显著差异。奥美拉唑治疗组中住院期小于3天的患者占60.5%，而安慰剂组占49.2%(P=0.005)。在内镜检查时，奥美拉唑治疗组比安慰剂组中有活动性出血性溃疡的患者少(12 /187, vs. 28 / 190; P=0.01),而有清洁基地部溃疡的患者多(120 vs. 90, P=0.001)。

结论：内镜检查前静脉滴注高剂量奥美拉唑促进溃疡出血消除并减少内镜治疗的必须性