质子泵抑制剂对危重监护病房医院获得性肺炎发展及预后的影响.doc

质子泵抑制剂对危重监护病房医院获得性肺炎发展及预后的影响 赵倩瑜1，卓 超1，黎毅敏2，钟南山2 （400016重庆，重庆医科大学附属第一医院呼吸科1；510120广州，广州医科大学附属第一医院重症医学科2） [摘要] 目的 探讨质子泵抑制剂（proton pump inhibitors，PPI）对危重监护病房（ICU）内医院获得性肺炎（hospital-acquired pneumonia，HAP）患者感染发展和预后的影响。方法 回顾性调查某教学医院2011年1-12月入住ICU，并存在误吸危险因素的HAP患者临床信息，根据是否使用PPI分组，对照分析2组肺炎进展和预后情况，并分析PPI剂量对肺炎的影响。结果 符合入选条件者共65例，PPI组患者45例，对照组为20例。基线调查2组基础疾病和各项感染指标，均无统计学差异。经过1周综合治疗后，PPI组与对照组患者相比，体温（40%）、白细胞计数（62.2%）、氧合指数（75.6%）、动脉血气pH值（51.1%）及A-aDO2异常者（77.8%）较多；影像学上可观察到PPI组更易出现感染灶增多情况（51.1%），更易合并血流感染（40.0%）；评估抗感染治疗效果PPI组较差，28d死亡率较高（37.8%），差异具有统计学意义（P＜0.05）。PPI剂量对HAP感染加重与否无明显影响（P＞0.05）。 结论 使用PPI的HAP患者抗感染治疗效果较未使用者差，且预后欠佳，在HAP的治疗中，需慎重应用PPI。不同的PPI剂量，对肺炎发展影响不明显。 [关键词] 质子泵抑制剂；医院获得性肺炎；危重监护病房 [中图法分类号] [文献标志码] A [通信作者] 卓 超，E-mail：chaosheep@ [优先出版] Influence of the proton pump inhibitors on the process and prognosis of hospital-acquired pneumonia in intensive care unit Zhao Qianyu，Zhuo Chao，Li Yimin，Zhong Nanshan (1Department of Respiratory Diseases, First Affiliated Hospital , Chongqing Medical University, Chongqing, 400016; 2Department of Intensive Care Unit, First Affiliated Hospital of Guangzhou Medical University, Guangzhou,Guangdong Province,510120,China) [Abstract] Objective To study the influence of the proton pump inhibitors (PPI) on the process and prognosis of hospital-acquired pneumonia (HAP) patients in intensive care unit (ICU). Methods This study focused on the comparative analysis of the process and prognosis situation between the patients with and without PPI treatment. The comparative analysis was performed based on the clinical information of the past HAP cases in which the patients were hospitalized in the ICU and were in the danger of aspiration form the an affiliated hospital of a medical college between Jan 2011 and Dec 2011. And then the influence of the PPI over these cases was investigated according to the different doses. Results A total of 65 cases of HAP were investigated in this study. In 45 cases, the PPI was used