质子泵抑制剂联合早期肠内营养防治脑卒中应激性溃疡临床研究

Clinical studies of early enteral nutrition applied to controlling stress ulcer in patients with stroke with proton pump inhibitors

目的探讨质子泵抑制剂联合早期肠内营养用于预防脑卒中应激性溃疡的临床效果。方法选取脑卒中患者100例,随机分为2组,A组(n=48)单纯给予质子泵抑制剂,B组(n=52)在A组基础上联合早期肠内营养。对2组患者应激性溃疡发生率、胃酸水平以及预后进行统计。结果A组轻症患者胃液潜血率、大便隐血率以及应激性溃疡率分别为6.90%、3.45%和10.34%,B组分别为3.15%、0和3.15%,2组差异无统计学意义(P>0.05)。A组重症患者胃液潜血率、大便隐血率以及应激性溃疡率分别为42.11%、21.05%、63.16%,B组分别为15.00%、5.00%和20.00%,A组明显高于B组,差异有统计学意义(P<0.05)。A组患者24h平均pH值、24h中位pH值、夜间平均pH值、夜间中位pH值分别为6.01±0.57、6.08±0.33、6.02±0.70和6.05±0.37,B组分别为6.93±0.52、7.34±0.29、6.83±0.59和6.98±0.41,A组明显低于B组;A组患者24hpH<4时间以及夜间pH<4时间分别为(3.10±0.33)%和(2.12±0.58)%,B组分别为(2.09±0.42)%和(1.18±0.54)%,A组明显高于B组,差异有统计学意义(P<0.05)。A、B组治愈率分别为39.58%、50.00%,A组明显低于B组;A、B组病死率分别为12.50%、3.85%,A组明显高于B组,差异有统计学意义(P<0.05)。结论质子泵抑制剂联合早期肠内营养可有效减少脑卒中患者应激性溃疡的发生率,提高患者的胃液pH值,改善患者预后,是一种良好的治疗方案。

Objective To investigate clinical effects of early enteral nutrition combined with proton pump inhibitors in treatment of stress ulcer in stroke patients and its influence on prognosis .Methods 100 patients with stroke were randomly di‐vided into groups A （n=48 only treated with proton pump inhibitors） and group B （n=52 treated with proton pump inhibitors plus early enteral nutrition） .The incidence rate of stress ulcer ,gastric acid levels and prognosis in two groups were colected and analyzed statistically .Results Rate of gastric occult blood , fecal occult blood and stress ulcer in the mild of group A was 6 .＆nbsp;90% ,3 .45% and 10 .34% ,while 3 .15% ,0 and 3 .15% in group B ,so the difference were small ,no statistically significant （P〉0 .05） .Rate of gastric occult blood ,fecal occult blood rate and stress ulcer rates in the severe were 42 .11% ,21 .05% , 63 .16% ,while 15 .00% ,5 .00% and 20 .00% in group B ,so group A was obviously higher than group B ,statistically signifi‐cant（P〈0 .05） .The time of pH of group A was less than 4 during 24h and during the night were （3 .10 ± 0 .33）% and （2 .12 ± 0 .58）% ,group B being （2 .09 ± 0 .42）% and （1 .18 ± 0 .54）% ,which were significantly higher than group B and the differ‐ence was statistically significant .39 .58% in cure rate of group A was distinctly lower than 50 .00% of group B ,while 12 .50%in mortality rate of group A was distinctly higher than 3 .85% of group B ,the differences had statistical significance（P〈0 . 05） .Conclusion Proton pump inhibitor combined with early enteral nutrition can effectively reduce the incidence of stress ul‐cer ,increase gastric pH improve progrosis ,which is a good treatment .