Efficacy of Antisecretory Agents in Cardiosurgical Patients in the Early Postoperative Period
https://doi.org/10.15360/1813-9779-2006-1-59-64
Abstract
Objective. To compare the efficacy of antisecretory agents used to prevent early postoperative mucosal erosive and ulcerative lesions of the upper gastrointestinal tract (GIT) in patients undergone cardiac surgery under extracorporeal circulation (EC). The study was performed by stratification randomization. Sixty-three adult patients with acquired cardiac diseases who had undergone operations on the heart under EC were clinically and endoscopically examined. To prevent acute proximal GIT ulcerations in the early postoperative period, all the patients were given antisecretory agents: ^-histamine receptor blockers or proton pump inhibitors (PPI). A drug was chosen by the blind method (envelope one). One group (n=31) took ^-histamine receptor blockers, the other (n=32) received PPI (omeprazole). To examine the upper GIT mucosa and to determine gastric acid-producing function, esophagogastroduodenoscopy with parietal pH-metry and chromoscopy were performed on postoperative days 5 and 9. Analysis of the findings revealed acute erosive and ulcerative lesions in 12.7% of all the examinees only in the ^-blocker group. Suppressed hydrochloric acid was significantly pronounced in the PPI group, as evidenced by chromoscopy. In the H2-blocker and PPI groups, the mean gastric pH value was 2.4±1.0 and 5.5±06 (F=224 and 259, respectively; p=0.0001).
About the Authors
M. B. Yarustovsky
A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow
Ye. A. Shipova
A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow
A. V. Bobkova
A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow
T. K. Khaidurova
A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow
References
1. Шипова Е. А. Острые гастродуоденальные кровотечения как осложнение ближайшего послеоперационного периода у больных, перенесших хирургические вмешательства на сердце и сосудах (патогенез, диагностика, лечение): дис. … д-ра мед. наук. М. : НЦ ССХ; 2003.
2. Sakarafas G. H., Tsiotos G. G. Intraabdominal complications after cardiac surgery. Eur. J. Surg. 1999; 165 (9): 820—827.
3. Silva E., DeBasker D., Creteur J., Vincent J. Effect of vasoactive drags on gastric intramucosal Ph. Crit. Care Med. 1998; 26 (10): 1749—1758.
4. Van7der7Voort P. H., Zandstra D. F. Pathogenesis, risk factors, and incidence of upper gastrointestinal bleeding after cardiac surgery: is specific prophylaxis in routine bypass procedures needed? J. Cardiothorac Vasc. Anesth. 2000; 14 (3): 293—302.
5. Mythen M. G., Webb A. R. Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complications and cost Intensive Care Med. 1994; 20: 99—104.
6. Lazar H. L., Hudson H., McCann J. et al. Gastrointestinal complication following cardiac surgery. Cardiovasc. Surg. 1995; 3 (3): 341—345.
7. Кубышкин В. А., Шишин К. В. Эрозивно-язвенное поражение верхних отделов желудочно-кишечного тракта в раннем послеоперационном периоде. Consilium-Medicum. Приложение 2004; 6(4): 3—9.
8. Kantorova I., Svoboda P., Scheer P. et al. Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial. Hepatogastroenterology 2004; 51(57): 757—761.
9. Белоусова Е. А., Логинов А. Ф. Возможности блокаторов Н-2-гистаминовых рецепторов в современной гастроэнтерологии. Consilium Medicum. Приложение 2003; 3: 6—10.
10. Катцунг Б. Г. Базисная и клиническая фармакология в 2 томах / Пер. с англ. СПб., М.: Невский диалект, Изд во БИНОМ; 1998; 2.
11. Khan K. Parmacologic treatment of hypersecretory disorders. Resident Reporter. 2000; 5: 23—28.
12. Никонов Е. Л. Клинико-патогенетические особенности различных видов антисекреторной терапии у больных кислотозависимыми заболеваниями: автореф. дис…. д ра мед. наук. М.; 2004.
13. Лопина О. Д. Механизм действия ингибиторов протонного насоса. Рос. журн. гастроэнтерол., гепатологии, колопроктол. 2002; 2: 38—43.
14. Исаков В. А. Ингибиторы протонного насоса: их свойства и применение в гастроэнтерологии. М. : ИКЦ Академкнига; 2001.
15. Lamberts R., Brunner G., Solcia E. Effects of very long (up to 10 years) proton pump blockade on human gastric mucosa. Digestion. 2001; 64 (4): 205—213.
16. Gisbert J. P., Gonzalez L., Calvet X. et al. Proton pump inhibitors versus 2-antagonists: a meta-analysis of their efficacy in treating bleeding peptic ulcer. Aliment. Pharmacol. Ther. 2001; 15(7): 917—1043.
17. Takeyama Y., Matsui T., Motomura A. et al. Comparison of the therapeutic effects and acid suppression of H-2-receptor antagonist and proton pump inhibitor in patients with gastric body ulcer — a prospective controlled trial. Nippon-Shokakibyo-Gakkai-Zasshi 1999; 96(5): 502.
18. Гельфанд Б. Р., Мартынов А. Н., Гурьянов В. А., Шипилова О. С. Профилактика стресс повреждений верхнего отдела желудочно-кишечного тракта у больных в критических состояниях. Consilium-Medicum. Приложение. Хирургия 2004; 2: 16—20.
Review
For citations:
Yarustovsky M.B., Shipova Ye.A., Bobkova A.V., Khaidurova T.K. Efficacy of Antisecretory Agents in Cardiosurgical Patients in the Early Postoperative Period. General Reanimatology. 2006;2(1):59-64. (In Russ.) https://doi.org/10.15360/1813-9779-2006-1-59-64
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