中风患者并发应激性溃疡的联合治疗探索

Early enteral nutrition combined with omeprazole for prevention of stress ulce in patients with cerebral apoplexy

目的探讨早期肠道营养联合奥美拉唑预防中风(脑卒中)患者并发应激性溃疡的效果.方法选取2013-06/2016-06华中科技大学附属梨园医院康复医学科收治的脑卒中患者52例为研究对象,随机分为治疗组与对照组,对照组患者单纯给予早期肠道营养预防,治疗组给予早期肠道营养联合奥美拉唑预防治疗,对比两组患者治疗1 wk后胃内p H值、住院时间、出血发生时间,并观察两组患者应激性溃疡发生率、死亡率,同时观察两组患者不良反应发生情况.结果与对照组对比,观察组患者夜间平均胃内p H、24 h平均胃内p H均明显升高,且夜间p H<4.0及p H<4.0的发生率明显减少(P<0.05);与对照组对比,观察组患者的住院时间明显缩短,出血发生时间明显推后,应激性溃疡发生率及死亡率明显降低(P<0.05);与对照组对比,观察组患者的大便潜血率及胃液潜血率均明显降低(P<0.05);观察组与对照组患者失眠、肝功能异常、头痛的发生率对比无明显差异(P>0.05);治疗前,观察组与对照组患者的SAS评分无明显差异(P>0.05),治疗后,观察组患者的SAS评分明显低于对照组(P<0.05).结论在早期肠道营养的基础上联用奥美拉唑可有效降低脑卒中患者并发应激性溃疡的发生率,效果显著,值得临床推广.

AIM To evaluate the preventive effect of early enteral nutrition combined with omeprazole on stress ulcer in patients with cerebral apoplexy.METHODS Fifty-two patients with cerebral apoplexy treated at our hospital from June 2013 to June2016 were selected and randomly divided into a treatment group and a control group.The control group was given early enteral nutrition alone,and the treatment group was given early enteral nutrition combined with omeprazole.Gastric pH at 1 wk after treatment,length of hospital stay,bleeding time,stress ulcer incidence,mortality,and adverse reactions were compared between the two groups.RESULTS Compared with the control group,mean nocturnal gastric pH and 24-h mean gastric pH were significantly increased and the incidence rates of nocturnal gastric pH 4.0 and pH 4.0significantly decreased（P〈0.05）;the length of hospital stay was significantly shorter;bleeding was significantly postponed;the incidence rates of stress ulcer and mortality were significantly decreased（P〈0.05）;and the percentages of patients with fecal occult blood and gastric occult blood were significantly decreased（P〈0.05） in the observation group.There was no significant difference in the incidence of insomnia,headache,or abnormal liver function between the two groups（P〈0.05）.Before treatment,there was no significant difference in SAS score between the two groups（P〈0.05）;however,after treatment,SAS score was significantly lower in the observation group than in the control group（P〈0.05）.CONCLUSION Early enteral nutrition combined with omeprazole can effectively reduce the incidence of stress ulcer in patients with cerebral apoplexy.