雷米普利预防卒中相关性肺炎的临床研究

摘要

目的 探讨血管紧张素转换酶抑制剂(ACEI)类药物雷米普利对卒中相关性肺炎(SAP)的预防作用及机制. 方法 采用前瞻性、随机、对照设计将404例伴高血压的急性脑卒中患者分为A组和B组,每组各202例.A组患者口服雷米普利从2.5 mg/d起始,1周后加量至5 mg/d;B组患者口服坎地沙坦从4mg/d起始,1周后加量至8 mg/d.对所有患者进行标准吞咽功能评估(SSA),比较两组患者在28 d治疗期内吞咽障碍的改善情况和SAP的发病率. 结果 A组有10例患者发生SAP,发病率为5.0％(10/202);B组为21例,发病率为10.4％(21/202),A组SAP发病率低于B组(x2=4.228,P=0.040).所有404例患者中入组时SSA阳性率为47.5％(192例),而31例发生SAP的患者入组时SSA阳性率为87.1％,高于总体比率47.5％.治疗后两组吞咽障碍的人数均明显减少,A组由97例减至18例(18/202,8.9％),恢复率为81.4％;B组由95例减至32例(32/202,15.8％),恢复率为66.3％,治疗后SSA阳性患者数差异有统计学意义(x2=4.474,P=0.034). 结论 雷米普利能有效地降低SAP的发生,同时促进吞咽障碍患者的功能恢复.%Objective To investigate the prevention of stroke-associated pneumonia (SAP) with Ramipril.Methods 404 acute stroke patients with primary hypertension were randomized into two groups.Group A received ramipril 2.5 mg once daily orally,and then were titrated up to 5 mg/d after a week.Group B received Candesartan 4 mg once daily orally,and then were titrated up to 8 mg/d after a week.The treatment course was 28 days.All patients received examination of Standardized Swallowing Assessment (SSA).The amelioration of swallow function and incidence of SAP after treatment were compared between the two groups.Results There were 10 patients suffering from SAP in group A and 21 patients in group B.The incidence of SAP was lower in group A(5.0％)than in group B(10.4％)(P＜0.05).The positive rate of SSA was 87.1 ％ in patients with SAP,higher than the total rate (47.5％).Dysphagia was improved in both groups after treatment.The rate of dysphagia improvement in group A and group B was 81.4％ and 66.3％ respectively.There was significant statistics difference in the positive case of SSA between two group (P＜ 0.05).Conclusions Orally treatment with ramipril is effective to prevent stroke-associated pneumonia and toimprove swallow function.