奥美拉唑的使用对呼吸机相关性肺炎发生率的影响

发布时间：2018-03-10 07:35

  本文选题：奥美拉唑　切入点：不同应用时间　出处：《泰山医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的:观察颅脑外伤术后不同时间使用奥美拉唑对ICU机械通气患者呼吸机相关肺炎(VAP)的发生率的影响。方法:选取ICU中颅脑外伤术后需接受机械通气的患者120例,所有患者均签署知情同意书。根据奥美拉唑的应用时间将120例患者根据数字随机表法随机分为4组,分别为使用奥美拉唑(1次/d,40mg/d静脉滴注)3d、5d、7d、15d。各组患者均每隔8h抽取胃管内胃液,应用p H精密试纸测定患者胃液p H值。在实验开始后头3d每日留一次痰及胃液,进行细菌培养,同时应用咽试子病菌培养观察咽喉部位的病菌。同时观察VAP患者下呼吸道病原菌分布。结果:1、奥美拉唑不用应用时间各组在年龄、平均年龄、性别、机械通气时间、PEEP、APACHEII评分及格拉斯哥昏迷评分等一般资料的比较中,P值0.05,差异无统计学意义,可参与比较。2、120例患者中,共发生VAP49例,发生率为40.83%;其中奥美拉唑3d组VAP发生率为30.00%、5d组为36.67%、7d组为43.33%、15d组为53.33%。120例患者共发生应激性溃疡13例,发生率为10.83%;其中奥美拉唑3d组应激性溃疡的发生率为16.67%、5d组为16.67%、7d组为6.67%、15d组为3.33%。与前三组相比,15d组在VAP及应激性溃疡的发生率方面差异显著(P0.05)。3、奥美拉唑应用3d组胃液p H值为1.2±0.7,5d组为2.6±0.5,7d组为4.0±0.8,15d组则为5.3±0.6;与前三组相比,15d组胃液p H值变化最为显著(P0.05);详见表3。120例患者共检测胃液p H值两次,送检胃液标本共计240例,其中147例标本中含有定植菌,定植率为61.25%。胃液p H值对有无VAP的患者的胃内定植菌无差别影响(P0.05)。但VAP总定植标本数为67例,定植率为68.37%;无VAP的患者胃内总定植菌数为80例,定植率为56.34%。两组差异显著(P0.05)。4、胃液p H值4时,以G-杆菌定植最多,VAP组定植率为52.38%、无VAP组定植率为40.14%,两组差异显著(P0.05);胃液p H值≤4时,以念珠菌定植最多,两组定植率均为14.29%,两组无显著差异(P0.05)。5、经标本分离后可知,VAP患者经胃液标本检出病原菌83株,检出率为84.69%;以念珠菌、G+球菌、G-球菌、阴沟肠杆菌、大肠埃希菌居多;咽试子标本检出病原菌株143株,检出率为145.92%;以念珠菌、G+球菌、G-球菌、鲍曼不动杆菌、铜绿假单胞菌居多。VAP患者口咽部及胃内的检出菌以念珠菌、G+球菌、G-球菌以及鲍曼不动杆菌、沙雷菌、阴沟肠杆菌、克雷伯杆菌差异显著(P0.05)。6、VAP患者下呼吸道病菌共检出160株病原菌,以铜绿假单胞菌(27.50%)、金黄色葡萄球菌(16.25%)、鲍曼不动杆菌(10.00%)、念珠菌(10.00%)、肺炎克雷伯菌(6.88%)居多。结论:ICU患者行机械通气治疗时,随着胃液p H值增加,应激性溃疡的发生率降低、VAP发生率增加。1、胃液p H值是影响胃内定植菌的重要因素,VAP患者分离的病原菌以革兰氏阴性杆菌居多,通过对病原菌的表型分析后病原菌感染途径为胃腔、口咽部、下呼吸道,从而引起VAP。2、对于ICU机械通气患者,使用适当时间的奥美拉唑能够保持胃液p H维持在适当程度,可降低VAP发生率。
[Abstract]:Objective: to observe the effect of omeprazole on the incidence of ventilator-associated pneumonia (VAP) in patients with ICU after craniocerebral trauma. According to the time of omeprazole's application, 120 patients were randomly divided into 4 groups according to the method of digital random list. Each group was treated with omeprazole 40 mg / d intravenously for 3 days, 5 days, 7 days and 15 days. The gastric juice was extracted every 8 hours in each group. The pH value of gastric juice was measured with pH precision test paper. Sputum and gastric juice were left once a day for bacterial culture in the first three days after the beginning of the experiment. At the same time, the germs in throat were observed by using pharynx test bacteria culture, and the distribution of pathogens in lower respiratory tract of patients with VAP was also observed. Results: 1, omeprazole did not need to be used in each group in age, average age, sex, etc. There was no significant difference in the mean time of mechanical ventilation (P 0.05) between PEEPV Apache II score and Glasgow coma score. There was no significant difference between them. VAP49 was found in 120 patients who could take part in the comparison of PEEPN and Glasgow coma score. The incidence of VAP in omeprazole 3d group was 30.005d, and the incidence rate of omeprazole 36.67D group was 43.333.330.120 cases of stress ulcer was found in Omeprazole 3d group, 53.330.120 cases in Omeprazole group, 36.67D group, 53.330.120 cases in 15 d group, there were 13 cases of stress ulcer. The incidence of stress ulcer in omeprazole group was 16.67 days, 16.67 days after treatment, and 6.67g / 15d group (P < 0.05). The incidence of stress ulcer in omeprazole group was significantly higher than that in the first three groups (P 0.05. 3). The gastric juice of omeprazole group was treated with omeprazole for 3 days group, compared with the first three groups, the incidence rate of stress ulcer in the 15 day group was significantly higher than that in the control group (P < 0. 05. 3). The incidence of stress ulcer in omeprazole group was 16. 67 days. The pH value of gastric juice in group A (1.2 卤0.7d) was 2.6 卤0.5d (4.0 卤0.815d), and that in group B (5.3 卤0.6d) was 5.3 卤0.6.The pH value of gastric juice in 15d group was the most significant than that in group 鈪，

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