奥美拉唑与脑卒中相关性肺炎的关系研究

Study on the relationship between the application of omeprazole and stroke-associated pneumonia

目的探讨无法进食经鼻饲的急性脑卒中患者给予奥美拉唑后胃液pH值、胃腔细菌定植情况以及对应激性消化道溃疡、卒中相关性肺炎(SAP)的影响。方法 90例患者依据奥美拉唑应用时间随机分为三组,每8小时抽取胃液,测pH值及潜血试验。留取胃液、深部痰行细菌培养。结果三组胃液pH值、各组SAP发生率差异有统计学意义;三组应激性溃疡的发生率差异无统计学意义。90例患者中31例发生胃腔细菌定植,三组差异有统计学意义。胃腔细菌定植患者pH值与无细菌定植患者胃液pH值差异有统计学意义;发生胃腔细菌定植细菌主要为革兰阴性杆菌;17例SAP患者痰细菌培养主要为革兰阴性杆菌。17例SAP患者pH值与非SAP患者胃液pH值差异有统计学意义;急性脑卒中鼻饲患者,应用奥美拉唑时间延长,胃液pH增加,胃腔细菌定植增多,SAP发生率增加,应激性溃疡发生率下降。结论对于急性脑卒中患者应选择应用奥美拉唑时间,需监测胃液pH值,使胃液pH值保持适当范围。

Objective To explove the impact of not eat after acute brain stroke patients with nasal feeding given omeprazole, observed at different time after application of omeprazole pH value of gastric juice, gastric cavity of bacte- rial colonization, and on stress ulcer, stroke associated pneumonia （SAP）. Methods In 90 patients, on the basis of omeprazole application time were randomly divided into 3 groups, each 8h gastric fluid, measured the pH value and the occult blood test. Specimens from the gastric juice, deep sputum bacterial culture. Results Three groups, each group the pH value of gastric juice SAP occurrence rate were significantly different between the three groups; stress ul- cer incidence rate showed no significant difference. In 90 cases, 31 cases of gastric cavity bacterial colonization, there was significant difference between three groups. There was statistical significance of bacterial colonization in patients with gastric lumen pH value and without bacterial colonization in patients with gastric pH value difference; the inci- dence of gastric cavity colonization bacteria mainly gram-negative bacilli; 17 cases of SAP patients with sputum bacte- rial culture, mainly gram-negative bacilli. There was statistical significance in 17 patients with SAP and non SAP pa- tients with pH value of the pH value of gastric juice difference; Conclusion Nasal feeding patients with acute stroke, omeprazole time prolonged, PH of gastric juice, gastric cavity colonization increased, the incidence rate of SAP in- creased, the incidence of stress ulcer decreased. Therefore, for acute stroke patients should choose omeprazole time, the need for monitoring the pH value of gastric juice, the pH value of gastric juice to maintain proper range.