重症颅脑损伤合并胃肠和肺部感染与质子泵抑制剂的关系研究

Relationship between gastrointestinal and pulmonary infection with PPIs in severe craniocerebral injury patients

目的分析重症颅脑损伤患者使用质子泵抑制剂(PPIs)出现胃肠道感染、医院获得性肺炎(HAP)的发生率,探讨重症颅脑损伤患者如何正确使用PPIs。方法查阅2011—2012年入院的141例重症颅脑损伤患者的病历,按未使用PPIs(17例)、长时间使用PPIs(59例)与短时间使用PPIs(65例)分为3组,并对使用PPIs后相关感染风险因素进行分析。结果使用PPIs组中胃肠道感染、HAP发生率较高,特别是长时间(超过9d)使用者。用不同多变量的logistic回归分析,经GCS评分校正后,长时间使用PPIs是一风险因素。结论长时间使用PPIs可能是重症颅脑损伤患者胃肠道感染及HAP的风险因素之一。临床使用PPIs时,除考虑病情外,还应注意使用时间。

Objective To analyze the occurrence rate of gastrointestinal and pulmonary infection and hospital acquired pneumonia （HAP）in severe craniocerebral injuries in my hospital using proton pump inhibitors （PPIs） ,discuss the right way to use PPIs for severe craniocerebral injuries .Methods The case histories of 141 severe craniocerebral injuries in my hospital from 2011 to 2012 were looked up ,and divided into three groups as follows ：the group that never used PPIs（17 cases） ,the group that used PPIs for a long time （59 cases） ,and the group that used PPIs for a short time （65 cases） ,and the risks of getting infected using PPIs were analyzed in those three groups above .Results The patients in PPIs group had a higher risk of gastrointestinal tract infection and HAP ,especially who were treated with PPIs more than 9 days .Adjusted by GCS score ,using PPIs for a long time was a risk factor in different multivariate logistic .Conclusion Using PPIs for a long time might be a risk factor of gastrointestinal tract infection and HAP .Therefore ,apart from considering the state of illness ,more attention should be paid to the using time w hen use PPIs .