质子泵抑制剂对危重监护病房医院获得性肺炎发展及预后的影响

Effect of proton pump inhibitors on development and prognosis of hospital-acquired pneumonia in intensive care unit

目的探讨质子泵抑制剂(proton pump inhibitors,PPI)对危重监护病房(ICU)内医院获得性肺炎(hospitalacquired pneumonia,HAP)患者感染发展和预后的影响。方法回顾性调查某教学医院2011年入住ICU,并存在误吸危险因素的HAP患者临床资料,根据是否使用PPI分组,对照分析2组肺炎进展和预后情况,并分析PPI剂量对肺炎的影响。结果符合入选条件者共65例,PPI组患者45例,对照组为20例。基线调查2组基础疾病和各项感染指标,均无统计学差异。经过1周综合治疗后,PPI组与对照组患者相比,体温(40%)、白细胞计数(62.2%)、氧合指数(75.6%)、动脉血气pH值(51.1%)及A-aDO2异常者(77.8%)较多;影像学上可观察到PPI组更易出现感染灶增多情况(51.1%),更易合并血流感染(40.0%);评估抗感染治疗效果PPI组较差,28 d死亡率较高(37.8%),差异具有统计学意义(P<0.05)。PPI剂量对HAP感染加重与否无明显影响(P>0.05)。结论使用PPI的HAP患者抗感染治疗效果较未使用者差,且预后欠佳。在HAP的治疗中,需慎重应用PPI。不同的PPI剂量,对肺炎发展影响不明显。

Objective To determine the effect of the proton pump inhibitors （PPI） on the develop- ment and prognosis of hospital-acquired pneumonia （HAP） patients in intensive care unit （ICU）. Methods A retrospective study was carried out on HAP patients with risk factors of aspiration from ICU of our hospital in the year of 2011. After their clinical data were collected, they were divided into 2 groups according to using PPI or not. The process and prognosis were compared between the 2 groups. And the effect of different doses of PPI was investigated. Results A total of 65 cases of HAP were recruited in this study. There were 45 cases receiving PPI treatment and the rest of 20 cases without during the disease course. No statistically difference was found in basic diseases and indicators of various infections between 2 groups. After 1 week＇ s treatment, there were more patients from PPI group having fever （40%）, increased white blood cell count （62.2%） , lower oxygenation index （75.6%）, lower arterial blood gas pH value （51. 1% ） and abnormal A-aDO2 （77.8%） than those from control group. In addition, CT scanning showed there were more patients having increased infectious loci （51.1%） and prone to bloodstream infection （40.0%）. The anti-infective effect of PPI was poor, and the mortality reached the highest on the day 28 （37.8 %）, with statistically difference between the 2 groups （ P 〈 0.05 ）. However, there was no difference （ P 〉 0.05 ） between the cases in which different defined daily doses （DDD） were applied. Conclusion PPI is beneficial to HAP patients in ICU, and even causes poor prognosis. In the treatment of HAP, PPI should be used with caution. Different doses of PPI have no effect on the progress of the disease.