质子泵抑制剂对伴吞咽障碍脑梗死患者营养状态的影响

目的：探讨质子泵抑制剂（PPI）的预防性使用对伴吞咽障碍的急性期脑梗死患者营养状态的影响。方法：共有155例伴吞咽障碍的脑梗死患者纳入研究，所有患者均予留置鼻饲管及常规的肠内营养，然后随机分配进入PPI组和对照组。PPI组给予泮托拉唑钠针静滴保护胃黏膜，对照组不进行胃黏膜保护治疗。比较2组患者在血清白蛋白、血红蛋白、肱三头肌皮褶厚度、上臂肌围、胃液pH值、NIHSS评分、急性胃黏膜病变（AGML）、病死率上的差异。结果：2组患者在入院时的血清白蛋白、血红蛋白、肱三头肌皮褶厚度、上臂肌围、胃液pH值、NIHSS评分上差异无统计学意义（P＞0.05）。入院2周时血清白蛋白、血红蛋白、肱三头肌皮褶厚度、上臂肌围均较入院时下降（P＜0.05），且PPI组下降更为显著（P＜0.05）。PPI组在入院2周时的NIHSS评分低于对照组（P＜0.05），AGML的发生率低于对照组（P＜0.05），但2组在病死率上差异无统计学意义（P＞0.05）。结论：PPI的使用对脑梗死患者的营养状态有不利的影响，其虽不影响患者的病死率，但影响脑梗死患者神经功能的恢复。故对伴吞咽障碍的脑梗死患者进行胃黏膜保护治疗时，需权衡患者营养不良的风险，做到个体化治疗。

The influence of proton pump inhibitor on nutritional status in patients with post-stroke dysphagia

Objective: To explore the influence of proton pump inhibitor (PPI) on nutritional status in patients with post-stroke dysphagia. Methods: A total of 155 cerebral infarction patients with dysphagia were enrolled in this study. All the patients were given enteral nutrition by a gastric tube. Then they were randomly assigned into the PPI treatment group and the control group. Pantoprazole was given the PPI group to protect the gastric mucosa. The control group didn’t give any gastric mucosa protective treatment. Then the hemoglobin, serum albumin, triceps skinfold thickness, arm muscle circumference, gastric juice pH, NIHSS score, acute gastric mucosal lesions (AGML) and mortality rate were compared between the two groups. Results: The two groups had no significant difference in hemoglobin, serum albumin, triceps skinfold thickness, arm muscle circumference, gastric juice pH and NIHSS score on admission (P>0.05). After two weeks, the hemoglobin, serum albumin, triceps skinfold thickness, arm muscle circumference in two groups both decreased (P<0.05), and the PPI group decreased more compared to the control group (P<0.05). Also the PPI group had a lower NIHSS score (P<0.05) and lower risk of AGML (P<0.05). But the two groups had no significant difference in mortality rate (P>0.05). Conclusion: The using of PPI will influence the nutritional status in patients with post-stroke dysphagia. Using PPI has a poor neurological outcome, but has no relationship with mortality rate. In the protective treatment of gastric mucosa in cerebral infarction patients with dysphagia, the clinicians should weigh the risk of dystrophy. Then, an individualized treatment to each patient is given.