硫糖铝与质子泵抑制剂对ICU机械通气患者呼吸机相关性肺炎的影响

doi:10.3969/j.issn.1002-1949.2017.12.011

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摘要目的：探讨硫糖铝与质子泵抑制剂（PPI）对ICU机械通气患者呼吸机相关性肺炎（VAP）的影响。方法：将90例入住上海市浦东医院综合ICU无上消化道出血高危因素的气管插管行机械通气的患者，随机分成硫糖铝组和PPI组（每组各45例）。除接受常规治疗外，硫糖铝组第1天开始给予硫糖铝混悬液鼻饲，持续1周；PPI组给予泮托拉唑针剂静滴，持续3 d 。收集、检测并记录两组患者的胃液pH值、痰培养，统计两组患者VAP和上消化道出血的发生率。结果： ①硫糖铝组有4例及PPI组有3例因不符合病例研究标准，最终被剔除本研究；②硫糖铝组胃液pH值（1.56±0.55），低于PPI组（2.41±0.50），差异有统计学意义（t=7.34,P＜0.01）；③硫糖铝组上消化道出血发生率（14.63%）,高于PPI组（9.52%）；VAP发生率（19.51%）低于PPI组（21.43%）,但差异均无统计学意义（P均＞0.05）；④硫糖铝组及PPI组检测的病原学分布差异无统计学意义（χ2=0.090,P=0.956）；两组共36株病原体中，革兰阴性菌检出率最高（75.0%），耐药菌均在晚发型VAP中检出，鲍曼不动杆菌最常见。总检出率排前3位分别为肺炎克雷伯菌、鲍曼不动杆菌及铜绿假单胞菌。结论：对于无上消化道出血高危因素的机械通气患者，应用硫糖铝与PPI对VAP和上消化道出血患者的发生率无影响；VAP病原学分布也无差异。

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	盛鹰
	王树云
	王静恩
	石齐芳
	谢晓洪
	高波
	朱念
	蔡金芳

收稿日期: 2017-07-28

基金资助:复旦大学附属浦东医院“浦秀”培养计划资助（PX201304）

通讯作者: 蔡金芳（1970-），女，副主任医师，科副主任，E-mail：sweetheart1999@126.com

作者简介: 盛鹰（1982-），男，副主任医师，科主任助理，急救医学教研室科教秘书。

引用本文:

盛鹰，王树云，王静恩，石齐芳，谢晓洪，高波，朱念，蔡金芳. 硫糖铝与质子泵抑制剂对ICU机械通气患者呼吸机相关性肺炎的影响[J]. 中国急救医学, 2017, 37(12): 1118-1122.
Sheng Ying, Wang Shu-yun, Wang Jing-en, Shi Qi-fang, Xie Xiao-hong, Gao Bo, Zhu Nian, Cai Jin-fang. The effects of sucralfate and proton pump inhibitors on ventilator-associated pneumonia of patients with mechanical ventilation in Intensive Care Unit. Chinese Journal of Critical Care Medicine, 2017, 37(12): 1118-1122.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2017.12.011 或 http://www.cnemergency.org.cn/CN/Y2017/V37/I12/1118

［1］Tabaeian SM, Yazdannik A, Abbasi S. Compliance with the standards for prevention of ventilator-associated pneumonia by nurses in the Intensive Care Units［J］. Iran J Nurs Midwifery Res， 2017, 22(1):31-36. ［2］Patil HV, Patil VC. Incidence , bacteriology, and clinical outcome of ventilator -associated pneumonia at tertiary care hospital［J］. J Nat Sci Biol Med， 2017， 8(1):46-55. ［3］Grindlinger GA, Cairo SB, Duperre CB. Pneumonia prevention in intubated patients given sucralfate versus proton-pump inhibitorsand/or histamine Ⅱ receptor blockers［J］. J Surg Res， 2016， 206(2):398-404. ［4］中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)［J］.中华内科杂志， 2013, 52(6):524-543. ［5］中华内科杂志，中华医学杂志，中华消化杂志，等.急性非静脉曲张性上消化道出血诊治指南(2015年，南昌)［J］.中华医学杂志, 2016, 96(4):254-259. ［6］Bardou M,Quenot JP, Barkun A. Stress-related mucosal disease in the critically ill patient［J］. Nat Rev Gastroenterol Hepatol, 2015, 12(2):98-107. ［7］Joret-Descout P, Dauger S, Bellaiche M, et al. Guidelines for proton pump inhibitor prescriptions in paediatric intensive care unit［J］. Int J Clin Pharm, 2017, 39 (1):181-186. ［8］Romo-Gamboa JP, Sandoval-Pérez BA,Rodríguez-López AB, et al. Risk factors related with ventilator-associated pneumonia in a neonatal intensive care therapy［J］. Rev Med Inst Mex Seguro Soc, 2017, 55(1):S72-S79. ［9］Xie DS, Xiong W, Lai RP, et al. Ventilator-associated pneumonia in intensive care units in Hubei Province, China: a multicentre prospective cohort survey［J］. J Hosp Infect, 2011, 78(4):284-288. ［10］Liu QH, Zhang J, Lin DJ, et al. Gastropulmonary route of infection and the prevalence of microaspiration in the elderly patients with ventilator-associated pneumonia verified by molecular microbiology-GM-PFGE［J］. Cell Biochem Biophys， 2015， 71(3): 1457-1462. ［11］Rama Bozorgmehr, Vanousheh Bahrani, Alireza Fatemi. Ventilator-associated pneumonia and its responsible germs; an epidemiological study［J］. Emerg (Tehran)， 2017， 5(1):e26. ［12］MacLaren R, Campbell J. Cost-effectiveness of histamine receptor-2 antagonist versus proton pump inhibitor for stress ulcer prophylaxis in critically ill patients［J］. Crit Care Med, 2014, 42(4):809-815. ［13］Chien-Chu Lin, Yeong-Long Hsu, Chen-Shuan Chung, et al. Stress ulcer prophylaxis in patients being weaned from the ventilator in a respiratory care center: A randomized control trial［J］. J Formos Med Assoc, 2016, 115(1):19-24. ［14］He H, Hu S, Chen Q, et al. Effects of sucralfate and acid-suppressive drugs on preventing ventilator-associated pneumonia of mechanically ventilated patients: a meta-analysis［J］. Zhonghua Nei Ke Za Zhi， 2014， 53(1):48-54. ［15］Alquraini M, Alshamsi F, Mller MH, et al. Sucralfate versus histamine 2 receptor antagonists for stress ulcer prophylaxis in adult critically ill patients: A meta-analysis and trial sequential analysis of randomized trials［J］. J Crit Care, 2017, 8(40):21-30. ［16］Eastwood GM, Litton E, Bellomo R, et al. Opinions and practice of stress ulcer prophylaxis in Australian and New Zealand intensive care units［J］. Crit Care Resusc, 2014, 16(3):170-174. ［17］Krag M, Perner A, Wetterslev J，et al. Stress ulcer prophylaxis in the intensive care unit: an international survey of 97 units in 11 countries［J］. Acta Anaesthesiol Scand, 2015, 59(5):576-585. ［18］Shears M, Alhazzani W, Marshall JC, et al. Stress ulcer prophylaxis in critical illness: a Canadian survey［J］. Can J Anaesth, 2016, 63(6):718-724. ［19］Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016［J］. Crit Care Med, 2017, 45(3):486-552. ［20］〓唐文学.机械通气患者获得性肺炎与奥美拉唑使用时间的相关性研究［J］.中国临床药理学杂志, 2014, 30(4):294-296. ［21］〓张应全，苏永棉，梁凤潇，等.胃液pH值与呼吸机相关性肺炎的相关性研究［J］.中国小儿急救医学， 2012， 19（2）：161-163.