Stress can decrease intragastric pH and cause erosion of gastric mucosa. Because cardiac surgery and cardiopulmonary bypass represent a major stress, the effects on intragastric pH of an H2-receptor antagonist, ranitidine, and an M1-muscarinic antagonist, pirenzepine, were evaluated. Intragastric pH was measured throughout elective cardiac surgery in 60 patients by a digital pH-meter during fentanyl-diazepam-nitrous oxide (50%) anesthesia. The gastric content was sampled at closure of the chest for bacterial count. Oral preoperative medication given randomly included (n = 20 in each group) 0.3 mg/kg diazepam 1 h before induction (group 1); diazepam plus ranitidine (150 mg) 1 h before induction (group 2); and diazepam plus pirenzepine (50 mg) on the evening before surgery and 1 h before induction of anesthesia (group 3). At induction intragastric pH was higher in group 2 (mean +/- SD = 7.42 +/- 1.07) than in group 1 (5.28 +/- 2.14) (P less than 0.01) but was not significantly different in group 3 (5.78 +/- 1.89) than in group 1. In no group did intragastric pH change significantly during surgery. Gastric juice was sterile in 92% of group 1, in 25% of group 2, and in 71% of group 3 patients (P less than 0.01). Postoperatively no gastrointestinal complications occurred, but there was a trend toward more patients developing nosocomial pneumonias in groups 2 and 3 (15%) than in group 1 (0%) (P = 0.06). Intraoperative intragastric pH is relatively high after diazepam premedication, thus the preoperative addition of ranitidine or pirenzepine would not be necessary and may possibly be hazardous.

译文

:压力可降低胃内pH值并引起胃粘膜糜烂。因为心脏手术和体外循环是主要的压力,所以评估了H2受体拮抗剂雷尼替丁和M1毒蕈碱拮抗剂哌仑西平对胃内pH的影响。在芬太尼-地西p-一氧化二氮(50%)麻醉期间,通过数字式pH计在整个择期心脏手术中对60例患者的胃内pH进行了测量。在胸部闭合时取样胃内容物以进行细菌计数。诱导前1小时随机给予口服术前药物(每组20例)0.3 mg / kg地西epa(第1组);诱导前1小时地西epa加雷尼替丁(150 mg)(第2组);在手术前的晚上和麻醉诱导前的1小时(第3组)和地西epa加哌仑西平(50 mg)。诱导时,第2组的胃内pH高于第1组(平均SD = 7.42 /-1.07)(第5.28 /-2.14)(P小于0.01),但第3组无明显差异(5.78 /-1.89)。与第1组相比。在手术期间,没有任何组的胃内pH发生显着变化。第1组的92%,第2组的25%和第3组的71%的患者的胃液是无菌的(P小于0.01)。术后未发生胃肠道并发症,但第2组和第3组(15%)比第1组(0%)有更多的患者发生医院内肺炎(P = 0.06)。地西epa预处理后,术中胃内pH值相对较高,因此术前不必添加雷尼替丁或哌仑西平,可能会很危险。

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