质子泵抑制剂对重症脑卒中患者管饲后胃液PH值的影响

摘要

Objective To evaluate the effect of proton pump inhibitors (PPI) on pH of gastric juice in patients undergoing severe stroke after intubation feeding. Methods 200 patients with severe stroke have been divided into two groups, one group included 152 cases who used PPI and the other groups included 48 cases who was control group and were given effective nutritional support and stop PPI three days later. Both groups were given enternal nutrition support. After four days each cases was monitored gastric juice pH at 1/2 h、1 h after intubation feeding and continued for 7 days. Condition of gastrointestinal bleeding was observed after admission. Results Average and median pH of gastric juice in two groups at 1/2h、1h after intubation feeding were compared. There were statistically significant differences between two groups (P<0.01). The treatment protocols, which 40mg omeprazole was given two times per day and was combined with early enternal nutrition, was compared with the protocal which only enternal nutrition was given,and pH was found to be increased significantly, and gastric acid suppression level was almost stabled at 6.0. But at control group, pH of gastric juice was 5.0. There was no difference between two groups in the incidence of stress ulcer, recovery rate, case fatality rate (P>0.05). Conclusion There was not effect on the incidence of stress ulcer, recovery rate and case fatality rate in patients with severe stroke if only effective nutrition support and stop PPI were given. Therefore, it is important to study the compatibility therapy of PPI and early enternal nutrition at present.%目的：探讨质子泵抑制剂（PPI)对重症脑卒中患者管饲后胃液pH值的影响。方法将200例重症脑卒中患者分为使用PPI组152例及对照组（3 d后给予有效营养支持即停PPI）48例。均于肠内营养支持第4天连续监测患者鼻饲后1/2 h、1 h胃液pH值7 d并观察入院后消化道出血情况。结果两组患者鼻饲后1/2 h、1 h平均胃内pH值及中位pH值间比较，差异均有统计学意义(P<0.01)。奥美拉唑用量40 mg 2次/d +早期肠内营养与单纯应用肠内营养（3 d后给予有效营养支持即停PPI）相比，胃内pH值明显增加，并保持胃内抑酸程度稳定在接近6.0的水平；而单纯应用肠内营养（3 d后给予有效营养支持即停PPI），胃内pH值稳定在5.0左右。但两组患者应激性溃疡发生率、治愈好转率以及病死率之间差异均无统计学意义(P>0.05)。结论给予有效营养支持后即停PPI可能对重症脑卒中患者应激性溃疡发生率、治愈好转率以及病死率无影响。因此，目前探索PPI和早期肠内营养的配伍治疗，PPI使用的剂量、疗程以及早期肠内营养的时机是重点。