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H2RA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H2RA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 (H2RA). 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 H2RA 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.
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