重型脑伤早期鼻饲硫糖铝山莨菪碱混悬液防治应激性溃疡效果分析

Efficacy of suspension of sucralfate and anisodamine by early nasal feeding for stress ulcer after severe brain injury

目的探讨鼻饲早期硫糖铝、山莨菪碱混悬液防治重型脑伤应激性溃疡的疗效。方法回顾性对比分析903例重型脑损伤患者应激性溃疡出血、肺部感染发生情况,其中380例(对照组)伤后72小时内无任何预防应激性溃疡措施;303例(A组)鼻饲雷尼替丁、甲氰咪胍、奥美拉唑;220例(B组)早期鼻饲硫糖铝和山莨菪碱混悬液。结果 B组无输血治疗病例及死亡病例,未发现鼻饲药物后的胃肠返流,未见腹胀和精神异常等阿托品样作用,应激性溃疡发生率、肺部感染发生率均明显低于对照组与A组,差异有统计学意义(P<0.01)。结论在治疗原发脑伤的同时,硫糖铝、山莨菪碱混悬液早期鼻饲对防治重型脑伤应激性溃疡具有重要临床价值,并能减少肺部感染发生率。

Objective To explore the efficacy of the suspension of sucralfate and anisodamine by early nasal feeding in order to prevent stress ulcer after severe brain injury.Methods We retrospectively analyzed the incidence of stress ulcer bleeding and pulmonary infection among the 903 cases of patients with severe brain injury,including 303 cases in group A,220 cases in group B and another 380 cases in the control group.In the control group,non measures were carried out to prevent stress ulcer within 72 hours after injury.Patients in group A were given ranitidine,cimetidine and omeprazole,while those in group B were given the suspension of sucralfate and anisodamine by early nasal feeding.Results There were no blood transfusion cases and deaths in group B.There was neither incidence of gastrointestinal reflux after given drugs by nasal feeding nor any atropine-like effect like abdominal distention and emotional disturbance.The incidence of stress ulcer and pulmonary infection in this group were 1.6% and 1.3% respectively,which were significantly lower than those data in group A and the control group（P 0.05）.Conclusion While the treatment of primary brain injury,the suspension of sucralfate and anisodamine by early nasal feeding has important clinical value for preventing stress ulcer after severe brain injury.Meanwhile,it can help to reduce the incidence of pulmonary infection.