伴吞咽障碍的脑梗死患者胃黏膜保护治疗的对照性研究

Protective Treatment of Gastric Mucosa in Cerebral Infarction Patients with Dysphagia

目的评价不同类型的药物在伴吞咽障碍的脑梗死患者中,胃黏膜保护治疗的有效性和安全性。方法共有215名伴吞咽障碍的脑梗死患者纳入研究,所有患者采用数字表法随机分入质子泵抑制剂(PPI)组、铝碳酸镁组和对照组。期间观察记录患者急性胃黏膜病变(AGML)和卒中相关性肺炎(SAP)的发生率。结果 PPI的胃黏膜保护效果优于铝碳酸镁(P<0.05),但其增加SAP的风险(P<0.01)。铝碳酸镁的胃黏膜保护效果虽不及PPI,但与对照组相比仍减少AGML的风险(P<0.01),且不增加SAP的风险(P>0.05)。结论对伴吞咽障碍的脑梗死患者进行胃黏膜保护治疗时,需权衡AGML和SAP的风险,做到个体化治疗。

Objective To evaluate the effectiveness and safety of gastric mucosa protective treatment in cerebral infarction patients with dysphagia. Methods A total of 215 cerebral infarction patients with dysphagia were enrolled in this study. All the patients were ran- domly assigned into the proton pump inhibitor（PPI） treatment group, the hydrotalcite treatment group and the control group. Then we ob- served the risk of acute gastric mucosal lesions（AGML） and the risk of stroke associated pneumonia（SAP） in each groups. Results The effectiveness of PPI in the gastric mucosa protective treatment was better than hydrotalcite（ P 〈 0.05 ） , but PPI could significantly increase the risk of SAP（ P 〈 0.01 ）. Though the effectiveness of hydrotalcite was worse compared with PPI, it also could significantly decrease the risk of AGML compared with the control group （ P 〈 0.01 ）. Hydrotalcite did not increase the risk of SAP（ P 〉 0.05 ）. Conclusion In the protective treatment of gastric mucosa in cerebral infarction patients with dysphagia, the clinicians should both access the risk of AGML and SAP. Then, giving an individualized treatment to each patient.