质子泵抑制剂与腹部外科手术患者医院获得性肺炎的相关性

Corelationship between proton pump inhibitors and hospital-acquired pneumonia in abdominal surgical patients

目的:探讨质子泵抑制剂(PPI)与腹部外科手术患者医院获得性肺炎(HAP)的相关性。方法:回顾性分析2010-2014年我院重症监护病房收治的腹部外科手术患者418例,按照用药分为PPI组(n=326)和HRA组(n=92),PPI组按用药分为奥美拉唑组(A组,n=146)、兰索拉唑组(B组,n=102)和潘妥拉唑组(C组,n=78),HRA组按H_2RA用药分为法莫替丁组(D组,n=58)和雷尼替丁组(E组,n=34),比较围手术期SUB发生率和HAP发生率,以及呼吸机通气时间、ICU住院时间和28 d病死率。结果:PPI组SUB发生率、HAP发生率、呼吸机通气时间、ICU住院时间和28 d病死率均低于非PPI组。PPI各亚组间SUB发生率、HAP发生率、呼吸机通气时间、ICU住院时间和28 d病死率比较差异无显著性。结论 :与使用H_2RA预防SUB比较,腹部外科手术患者使用PPI可减少SUB和HAP的发生率,缩短呼吸机通气时间和ICU住院时间,并降低28 d病死率;不同类型的PPI对腹部外科手术患者HAP发生率无影响。

Objective To investigate the corelationship between proton pump inhibitors（PPI） and the incidence of hospital-acquired pneumonia（HAP） in abdominal surgical patients. Methods A total of 283 cases admitted from 2010 to 2014 were divided into PPI group（n = 326） and HRA group（n = 92）. In PPI group,patients were divided into omeprazole subgroup（subgroup A, n = 146）, lansoprazole subgroup（subgroup B,n = 102） and pantoprazole subgroup（subgroup C, n = 78） by the types of PPI. In HRA group, patients were divided into famotidine subgroup（subgroup D, n = 58） and ranitidine subgroup（subgroup E, n =34） by the types of histamine-2 receptor antagonist（H_2RA）. The incidence of stress ulcer bleeding（SUB） and HAP were calculated, while mechanical ventilation period（MV）, ICU stay and 28-day-mortality were compared.Results There were lower incidences of SUB and HAP, shorter MV and ICU stay and lower 28-day-mortality in PPI group than those in HRA group（P〈0.05）. In three subgroups of PPI group, there were no significant difference on incidence rate of SUB and HAP, as well as MV, ICU stay and 28-day-mortality. Conclusion The incidence rates of SUB and HAP are lower by using PPI than H_2 RA in abdominal surgical patients, as well as MV, ICU stay and 28-day-mortality. Different types of PPI have no effect on the incidence rate of HAP in abdominal surgical patients.