硫糖铝与质子泵抑制剂对ICU机械通气患者呼吸机相关性肺炎的影响

The effects of sucralfate and proton pump inhibitors on ventilator - associated pneumonia of patients with mechanical ventilation in Intensive Care Unit

目的探讨硫糖铝与质子泵抑制剂（PPI）对ICU机械通气患者呼吸机相关性肺炎（VAP）的影响。方法将90例入住上海市浦东医院综合ICU无上消化道出血高危因素的气管插管行机械通气的患者，随机分成硫糖铝组和PPI组（每组各45例）。除接受常规治疗外，硫糖铝组第1天开始给予硫糖铝混悬液鼻饲，持续1周；PPI组给予泮托拉唑针剂静滴，持续3d。收集、检测并记录两组患者的胃液pH值、痰培养，统计两组患者VAP和上消化道出血的发生率。结果①硫糖铝组有4例及PPI组有3例因不符合病例研究标准，最终被剔除本研究；②硫糖铝组胃液pH值（1．564-0．55），低于PPI组（2．41±0．50），差异有统计学意义（t=7．34，P〈0．01）；③硫糖铝组上消化道出血发生率（14．63％），高于PPI组（9．52％）；VAP发生率（19．51％）低于PPI组（21．43％），但差异均无统计学意义（P均〉0．05）；④硫糖铝组及PPI组检测的病原学分布差异无统计学意义（x2=0．090，P=0．956）；两组共36株病原体中，革兰阴性菌检出率最高（75．0％），耐药菌均在晚发型VAP中检出，鲍曼不动杆菌最常见。总检出率排前3位分别为肺炎克雷伯菌、鲍曼不动杆菌及铜绿假单胞菌。结论对于无上消化道出血高危因素的机械通气患者，应用硫糖铝与PPI对VAP和上消化道出血患者的发生率无影响；VAP病原学分布也无差异。

Objective To investigate the effects of sucralfate and proton pump inhibitors （PPI） on ventilator - associated pneumonia （VAP） of patients with mechanical ventilation in Intensive Care Unit. Methods All of 90 cases which were not complicated with high risk factors of upper gastrointestinal bleeding were randomly divided into sucralfate group and PPI group. The patients of sucralfate group were given sucralfate for one week by nasal feeding, and PPI group were given pantoprazole for 3 days by intravenous injection. Two groups were treated with the same conventional therapy. The pH value of gastric juice and sputum culture of two groups patients were collected and tested. We also added up the incidence of VAP and upper gastrointestinal bleeding. Results Four cases of sucralfate group and three cases of PPI group were expelled, because of inconformity the research standard. Compared with PPI group, pH value of gastric juice were lower significantly insucralfate group （ t = 7.34, P 〈 0.01 ）. The incidence of upper gastrointestinal bleeding of sucralfate group was 14.63%, higher than PPI group which was 9.52% , and the incidence of VAP of sucralfate group was 19.51%, lower than PP! group which was 21.43%, however, the differences were not statistically significant （ P 〉 0.05 ）. The difference in the distribution of etiology among the groups was not statistically significant （ x2 = 0. 090, P = 0. 956 ）. The most frequent isolates were gram - negative bacteria which accounted for 75.0% in 36 strains of pathogens. All of the resistant bacteria were found in late - onset VAP, and the most common was Acinetobacter baumann II. The top three rates of total isolates pathogens were klebsiella pneumoniae, Acinetobacter baumann II , and pseudomonas aeruginosa. Conclusion In mechanical ventilation patients who are not complicated with high risk factors of upper gastrointestinal bleeding, the therapy of sucralfate and PPI has no effect on the incidence of VAP and upper gastrointestinal bleeding, and no difference on the VAP etiology distribution.