神经外科ICU病人胃液pH值、胃蛋白酶、定植菌与呼吸道感染的关系研究

[目的]了解神经外科ICU病人胃液pH值、胃蛋白酶含量及胃内细菌定植与呼吸道感染的关系,为临床给予及时的有效护理干预措施提供依据。[方法]选取北京市某三级甲等医院神经外科ICU病人进行连续3d的病情观察,并采集胃液进行pH值、胃蛋白酶含量检测及细菌培养,采集气管分泌物进行细菌培养。[结果]纳入47例病人,共收集235例次,胃液pH值为2.5~8.0(5.54±1.02);胃液pH值随ICU入住时间逐渐增加,酸度逐渐下降;胃液中胃蛋白酶含量为3.766ng/mL~84.482ng/mL,与胃液pH值呈负相关(r=-0.939,P0.001);76.6%病人胃液中含有定植菌,85.1%病人痰液中含有定植菌,病人胃液中细菌定植菌落与呼吸道细菌菌落呈现一致的比例为57.4%。[结论]对ICU重症病人进行胃液pH值监测,可动态观察病人的病情变化,及时合理地调节胃液的酸碱度,将胃液pH值控制在适当的范围,对于病人的治疗和预后具有重要意义。     

经口气管插管病人口腔内不同部位细菌定植状况观察

[目的]了解经口气管插管病人口腔内不同部位的细菌定植状况,为经口气管插管病人进行有针对性的口腔护理提供参考依据。[方法]随机纳入27例重症监护病房(ICU)机械通气病人,于常规口腔护理前后分别采集咽部、插管管壁可见末端、后臼齿咬合面的分泌物进行咽拭子细菌培养,比较口腔内不同部位细菌定植状况。[结果]3个部位细菌定植数量比较差异有统计学意义(P0.05);进一步两两比较可见:咽部细菌定植数、管壁可见末端细菌定植数高于后臼齿咬合面。[结论]咽部及插管管壁可见末端细菌定植数量多于后臼齿咬合面,可能与咽部的解剖结构及病人的体位有关。     

胃液细菌定植与重症脑出血患者呼吸机相关肺炎的关系研究

目的:研究重症脑出血机械通气患者胃内细菌定植在呼吸机相关性肺炎(VAP)发病中的作用。方法:对2011-01-2013-01入住我院急诊重症监护病房的重症脑出血机械通气患者进行胃液、口咽及下呼吸道标本的细菌培养,分析这3类标本的细菌种类是否存在一致性,同时检测胃液的pH值。结果:重症脑出血机械通气患者胃液、口咽及下呼吸道的标本细菌种类存在一致性,且定值组胃液pH值显著高于非定值组(P0.01)。结论:与胃液pH值升高相关的胃内细菌定植是重症脑出血机械通气患者VAP病原菌的重要来源。     

胃液pH值与呼吸机相关肺炎的研究

目的：研究胃液pH值与呼吸机相关肺炎（VAP）的发生率及病原菌的关系,探讨其临床意义,促进临床抗生素的合理应用。方法：选取2011年1月~2012年12月我院住院治疗并气管插管或气管切开行机械通气〉48 h的患者120例,测其胃内pH值,行胃液、口咽部、下呼吸道标本的细菌培养,分为VAP组和无VAP组两组,观察比较两组患者胃腔和口咽部病原菌种类与胃液pH值间的关系,以及发生VAP后胃液、下呼吸道标本中出现病原菌的种类、次序及药敏情况,比较胃内有定植菌组、无定植菌组与胃液pH值的关系,研究胃液pH对定植菌种类的影响。结果：通过研究发现胃液pH值与VAP发生率密切相关,pH〉4时,VAP发生率明显增加。且胃腔内多重耐药的产超广谱β内酰胺酶菌分离率明显上升,VAP组显著高于无VAP组;细菌生化反应结果和药敏谱显示：VAP下呼吸道多为革兰阴性杆菌,与胃腔内病原菌具有同源性。结论：胃液pH值直接影响患者呼吸机相关肺炎的发生发展,机械通气患者需监测胃液pH值,发生VAP早期联用对多重耐药革兰阴性菌的广谱抗生素,控制临床症状。     

神经外科术后病人麻醉复苏期呼吸道的预见性护理

[目的]总结神经外科术后病人麻醉复苏期的预见性护理措施。[方法]对240例神经外科手术病人给予预见性护理措施,主要包括强化床边交接制度、加强病情评估与监测、严格呼吸道管理、早期发现护理并发症。[结果]呼吸道并发症的发生率为10.8%,经及时有效的预见性护理,病人病情稳定,无麻醉复苏期死亡病例。[结论]神经外科术后病人在麻醉复苏期对呼吸道采用针对性的预见性护理措施有助于改善手术预后。     

经口气管插管病人口腔内不同部位细菌定植状况观察

[目的]了解经口气管插管病人口腔内不同部位的细菌定植状况,为经口气管插管病人进行有针对性的口腔护理提供参考依据.[方法]随机纳入27例重症监护病房（ICU）机械通气病人,于常规口腔护理前后分别采集咽部、插管管壁可见末端、后臼齿咬合面的分泌物进行咽拭子细菌培养,比较口腔内不同部位细菌定植状况.[结果]3个部位细菌定植数量比较差异有统计学意义（P〈0.05）;进一步两两比较可见：咽部细菌定植数、管壁可见末端细菌定植数高于后臼齿咬合面.[结论]咽部及插管管壁可见末端细菌定植数量多于后臼齿咬合面,可能与咽部的解剖结构及病人的体位有关.     

新生儿胃液PH值检测在胃液细菌培养中的意义

目的探讨新生儿出生后1 h胃液细菌培养与新生儿胃液PH值的关系。方法收集2019年1月-2020年5月到我院出生的新生儿,对新生儿出生后1 h内行胃液细菌培养和PH值测定。收集新生儿的临床资料及实验资料,以胃液细菌培养结果和PH值结果进行统计学分析。结果150例新生儿中PH<3.8有67例,PH>5.4有83例,胃液细菌培养阳性共52例,其中PH<3.8占0例,PH>5.4占52(62.7%)例,其中培养为大肠杆菌有26(31.3%)例,培养为葡萄球菌有10(12%)例,链球菌有16(19.3%)例。新生儿胃液PH值与胃液细菌定植显著相关(P<0.05)。结论胃液培养反映细菌定植状态,与母亲羊水情况有关。而胃液PH值则影响细菌的定植,起到抑制或杀灭细菌。结合新生儿胃液PH值和胃液细菌培养结果,进行预警或早期干预治疗。     

住院精神病病人口咽部定植菌群改变与医院感染的相关性研究

[目的]探讨住院精神病病人口咽部定植菌群的改变与呼吸道医院感染发生的关系。[方法]采集105例病人住院不同时期的273例次咽拭子标本进行细菌培养鉴定。[结果]入院后第1天、第5天、第21天奈瑟氏菌分离率均在80%以上。革兰阴性杆菌入院后第1天分离率为11.4%,第5天上升为22.8%,第21天为18.4%。口咽部有革兰阴性杆菌定植者呼吸道医院感染率高达52.4%。[结论]第5天口咽部革兰阴性杆菌分离率呈上升趋势,表明病人在住院初期可出现口咽部革兰阴性杆菌定植明显改变,且医院感染发生率高,因此应采取积极有效地预防措施。     

ICU呼吸机细菌污染调查结果与分析

[目的]了解本院ICU呼吸机细菌污染状况。[方法]细菌培养。[结果]检出11种39株细菌，其中醋酸钙不动杆菌检出率最高为25．6％；其次黄杆菌为20．5％；表皮葡萄球菌为15．3％。同时对病人气管分泌物进行细菌培养，检出结果与呼吸机检出细菌种类相符。[结论]呼吸机是ICU患者呼吸道感染的主要来源之一。     

重症监护病房多重耐药菌感染临床分析及护理干预

[目的]通过调查重症监护病房(ICU)多重耐药菌感染的临床分布情况,探讨降低多重耐药菌感染的护理防控措施。[方法]收集2014年1月—2015年12月ICU病人中有多重耐药菌感染的资料,分析多重耐药菌的种类、分布情况及与医院感染的关系。[结果]2014年1月—2015年12月ICU住院病人2547例,临床细菌培养标本中共培养出致病菌605株,其中多重耐药菌感染病人329株,占54.38%;发生医院感染病人135例,其中多重耐药菌医院感染79例,医院感染病例中多重耐药感染占58.52%。ICU多重耐药菌株中以鲍曼不动杆菌最多251株,占76.29%;ICU多重耐药菌感染主要感染部位为下呼吸道,占85.41%。[结论]多重耐药菌是ICU感染的主要致病菌,同时也是ICU医院内感染的主要致病菌;多重耐药菌病人感染部位以呼吸道为首位,临床实践显示,通过护理干预措施,可有效地预防与控制多重耐药菌在ICU的传播,降低医院感染率。     

碳酸酐酶Ⅵ与上消化道pH值平衡关系研究

目的探讨碳酸酐酶Ⅵ与上消化道pH值的关系。方法采集65例上消化道疾病患者的胃液,并进行胃液pH值、缓冲容量、碳酸酐酶Ⅵ浓度的检测,并分析其中的关系。结果碳酸酐酶Ⅵ浓度低的患者,胃液pH值低,且缓冲容量下降;胃液中含有碳酸酐酶Ⅵ,且碳酸酐酶Ⅵ浓度与胃液pH值、缓冲容量呈正相关（r=0.428、r=0.353,均P〈0.05）。结论碳酸酐酶Ⅵ对维持上消化道的pH值的平衡有重要作用。     

Gastric mucosal pH as a prognostic index of mortality in critically ill patients.

OBJECTIVE: To determine if measurements of gastric intramucosal pH have prognostic implications regarding ICU mortality. DESIGN: Prospective comparison of outcome. SETTING: General adult ICUs in two teaching hospitals. PATIENTS: Eighty consecutive patients age 18 to 84 yrs (mean 63.4), 50 men and 30 women, 55% in the medical and 45% in the surgical services. METHODS: Gastric intramucosal pH was measured on ICU admission and again 12 hrs later. A value of greater than or equal to 7.35 was used to differentiate between normal and low gastric intramucosal pH. MEASUREMENTS AND MAIN RESULTS: Fifty-four patients had a normal gastric intramucosal pH and 26 patients had a low gastric intramucosal pH on ICU admission. The mortality rate was greater in the low gastric intramucosal pH group (65.4% vs. 43.6%; p less than .04). The frequency of sepsis and the presence of multisystem organ failure also were greater in the low gastric intramucosal pH group (p less than .01). Further stratification of patients according to gastric intramucosal pH measured 12 hrs after admission showed a greater mortality rate in patients with persistently low gastric intramucosal pH when compared with patients with normal gastric intramucosal pH during the first 12 hrs (86.7% vs. 26.8%; p less than .001). CONCLUSIONS: Measurements of gastric intramucosal pH on ICU admission, and again 12 hrs later, have a high specificity for predicting patient survival in this ICU patient population (77.8% to 80.6%). Furthermore, given its relative noninvasive nature, tonometrically measured gastric intramucosal pH may be a useful addition to patient monitoring in the ICU.     

Gastric colonization and pneumonia in intubated critically ill patients receiving stress ulcer prophylaxis: a randomized, controlled trial.

OBJECTIVE: To study the effects of pharmacologically increasing gastric pH on gastric colonization and the development of pneumonia in intubated critically ill patients. DESIGN: Randomized, controlled trial. SETTING: Medical ICU in a university hospital. PATIENTS: Thirty-four tracheotomized patients with tetanus. INTERVENTIONS: Sixteen patients received iv ranitidine to increase gastric pH greater than 4 (ranitidine group), while 18 patients received no prophylaxis for upper gastrointestinal bleeding (control group). MEASUREMENTS AND MAIN RESULTS: Mean gastric pH was higher in the ranitidine group (median 4.7, range 3.6 to 6.1) than in the control group (median 2.1, range 1.2 to 4.9; p less than .05). Gastric colonization occurred in 15 (94%) of 16 patients who received ranitidine, 2 days (median; range 1 to 5) after intubation; gastric colonization also occurred in all control patients (median 4 days, range 1 to 9; p less than .05). Pneumonia occurred in 13 (81%) of 16 patients who received ranitidine, 3 days (median, range 1 to 5) after intubation and in nine (50%) of 18 control patients (p less than .01) 5 days after tracheal intubation (median, range 3 to 14; p less than .01). Prior gastric colonization by the pathogen that caused pneumonia was demonstrable in nine (56%) of 16 patients who received ranitidine vs. eight (44%) of 18 control patients (p greater than .05). The risk for developing pneumonia in the ranitidine-treated group was highest in the first 4 days after tracheal intubation. There was no difference in the frequency of upper gastrointestinal hemorrhage in the two groups. CONCLUSIONS: Pharmacologically increasing gastric pH increases the risk for developing pneumonia in intubated critically ill patients. The pneumonia occurs earlier than in untreated control patients.     

ICU住院患者各部位真菌定植的情况分析

目的分析引起ICU住院患者定植阳性的真菌菌种分布及可能引起真菌定植阳性的部分危险因素,为临床对于可能发生的侵袭性真菌感染的预防和抢先治疗提供理论依据。方法收集2008年9月至2009年2月我院ICU住院75例患者的标本360份,来自咽拭子、肛周拭子、痰或气道吸出物、胃液及尿液,利用VITEK2-Compact鉴定菌种。结果360份标本共分离出定植阳性的真菌101株,12种,其中白色念珠菌60株,占59．4％;胃液中真菌定植阳性的比例最高,为60．0％,尿液最低为6．6％;未发现同一标本中有两种或两种以上定植阳性的真菌,但有9例患者在不同部位出现两种定植阳性的真菌;手术及肠内外营养与胃液真菌定植阳性无明显相关性（P均〉0．05）。结论由白色念珠菌引起的胃液真菌定植阳性在ICU住院患者中最为常见,应提高警惕,及时预防。     

Assessment of gastric acidity in intensive care patients: Intermittent pH registration cannot replace continuous pH monitoring

Objective To test the accuracy of colour-scaled indicator papers to measure pH values and to study the correlation between this method of measuring gastric juice pH once daily and 24-h continuous intragastric pH monitoring in intensive care patients.Design The accuracy of indicator papers was tested in the laboratory using colourless solutions and aspirated gastric juice and was then verified with a laboratory pH meter. Continuous intragastric pH monitoring was performed in mechanically ventilated ICU patients. Percentages of time with a pH value <3.0 and median pH values by 24-h continuous intragastric pH monitoring were compared to pH values measured once daily with indicator paper.Setting A mixed ICU.Patients A total of 150 measurements were taken by continuous pH monitoring in 91 mechanically ventilated ICU patients.Measurements and results The correlation between the pH measured with the indicator paper and subsequently verified with a laboratory pH meter in colourless solutions was 0.96 [regression coefficient (RC) 0.98, 95% confidence interval (CI) 0.91–1.05]. Measured in gastric juice it was 0.95 (RC 0.95, 95% CI 0.88–1.01). The correlation between median pH values, determined with 24-h continuous intragastric pH monitoring, and values measured with indicator papers was 0.39 (RC 0.43, 95% CI 0.26–0.59). The mean difference in pH, as determined by the analysis of Bland and Altman [22], was 0.9 with a SD of 4.7. The correlation between the percentage of time with pH<3.0, as obtained with continuous registration, and median gastric pH values (also obtained with continuous registration) was–0.94 (RC–0.06, 95% CI–0.06-–0.05); the correlation between the time and gastric pH values (measured with indicator paper) was–0.40 (RC–0.02, 95% CI–0.03-–0.02).Conclusion The colour-scaled indicator paper is an accurate method of measuring pH values, but there is a poor correlation between gastric pH values measured once daily and a total measurement derived from 24-h continuous intragastric pH monitoring. Changes in intragastric pH values cannot be accurately studied when measuring acidity once daily. The influence of various treatment regimens on intragastric acidity in relation to the development of gastric colonization and nosocomial pneumonia should be investigated either with continuous intragastric monitoring or with frequent measurements in aspirated gastric juice.This study was made possible by a grant (28-2125) from the Praevention Foundation     

神经外科ICU患者胃内容物反流误吸的影响因素分析

目的了解神经外科ICU患者胃内容物反流及误吸的发生率,分析发生误吸的高危因素,为临床及时给予有效护理干预措施,预防误吸发生,减轻误吸并发症提供依据。方法选取某三级甲等医院神经外科ICU机械通气患者进行病情观察,收集年龄、性别、体位、意识状态、胃潴留量、鼻饲管口径、人工气道气囊压力等数据,采集咽喉部分泌物及气管分泌物,进行胃蛋白酶检测。结果观察235例次患者,胃内容物反流的发生率为48.1%,误吸发生率为38.3%。经单因素分析得出不同胃管直径型号、气管插管/气管切型号、鼻饲液泵入速度、胃潴留量、Glasgow评分、气囊压力及是否使用镇静剂患者误吸发生率差异有统计学意义(P0.05或P0.01)。进一步采用Logistic回归分析,患者误吸的影响因素为Glasgow评分、鼻饲液泵入速度、胃潴留量和气囊压力。结论根据胃内容物反流误吸的发生原因,随时观察患者的病情变化,特别注意患者的意识状态和胃潴留量,检测气管插管或气管切开的气囊压力,采取合理的鼻饲液泵入速度,以降低胃内容物反流误吸率。     

Prognostic value of gastric intramural pH in surgical intensive care patients

Gastric intramural pH (pHi), which has been shown to reflect the adequacy of oxygenation in peripheral tissue beds, was measured in acutely ill surgical patients in order to evaluate its value as a prognostic factor and its relation to the sepsis score. Fifty-nine surgical patients were studied on ICU admission. The stomach wall pH was calculated from the PCO2 in gastric juice and arterial bicarbonate concentration using the Henderson-Hasselbalch equation. A fall in tissue pH less than 7.32 was taken as an indication of inadequate tissue oxygenation. Patients with sepsis scores greater than 10 were considered septic. Hospital and short-term (within 72 h of admission) mortality rates were determined. A significantly higher short-term mortality rate was observed in patients having a pHi less than 7.32 (37% vs. 0%, p less than .005). Most (90%) of the septic patients had a pHi less than 7.32. The short-term mortality rate was the highest (50%) in the septic group. In this group also, a linear correlation was found between pHi and the sepsis score (r = -.43, p less than .01). Gastric pHi, however, offered no prediction for the long-term outcome.     

Effects of gastric alkalization on bacterial colonization in critically ill patients

Gastric alkalization of critically ill patients is associated with bacterial and fungal overgrowth in gastric contents. We studied the incidence of gastric colonization and its relation to other infections and antibiotic therapy in 25 critically ill ICU patients. All patients received 12-h NG Mylanta II and 15 received an H2-receptor antagonist. All patients had bacterial colonization of NG contents within 4 days of ICU admission and 10 had Candida colonization within 8 days. There were 70 NG isolates and the same isolates were found in tracheobronchial secretions (n = 46), blood (n = 4), urine (n = 4), and wounds (n = 8). Tracheobronchial colonization was preceded by NG colonization with the same organism in 12 instances (11 patients), was concurrent with NG colonization in 20 instances (14 patients), was followed by NG colonization in 14 instances (11 patients), and had no similar NG isolate in 18 instances (11 patients). NG culture of the same organism preceded four of eight positive blood cultures. In 35 of 70 NG isolates and five of 11 subsequent tracheobronchial isolates, colonization occurred despite concurrent appropriate antibiotics. We conclude that colonization of alkalinized NG contents is universal, is a common source of infection in other areas, and is not prevented by systemic antibiotic therapy. Local antibiotic therapy may be important in controlling this important source of infection.     

残胃患者泌酸功能的检测分析

目的：研究胃远端部分切除术后患者泌酸功能及其与黏膜病理改变、胆汁反流和幽门螺杆菌（Hp）感染的相关性。方法：采用24hpH监测仪测定51例残胃患者空腹胃内pH值，根据24h胃内平均pH值分为低泌酸组（pH≥3）和正常泌酸组（pH〈3）。胃镜观察残胃黏膜以及Hp检测。结果：低泌酸组患者35例，其中29例黏膜呈重度萎缩；正常泌酸组16例，其中4例呈重度黏膜炎症（P=0．006）。胆汁反流率在低泌酸组和正常泌酸组分别为37．4％和18．7％（P=0．014）。两组间Hp感染率无明显差异。62．7％的患者胃酸分泌减少，但却接受抑酸药物治疗。结论：24h动态胃pH监测可有效评价残胃患者胃黏膜泌酸功能。胆汁反流和残胃炎程度与黏膜泌酸功能有明显相关性。约1／3残胃患者保持正常冒酸分泌功能，临床卜有大量患者接詈了不必要的抑酪治疗．     

Etiology of decreased gastric nitric oxide in the critically ill.

BACKGROUND: Nitric oxide (NO) is present in the gas phase of the normal human stomach at a high concentration (1-10 ppm). The majority of this NO is produced from the reduction of dietary nitrate to nitrite and finally NO. Generation of this nonenzymatically produced gastric NO occurs only in an acidic environment. We examined NO concentrations in critically ill subjects and the mechanism for the observed perturbations. METHODS: Seven critically ill, intubated intensive care unit (ICU) patients (mean APACHE II score 16) and seven control patients were studied. Gastric NO concentrations were measured with a Sievers NO analyzer (GE, Boulder, CO). Nitrate and nitrite concentrations were determined by a modified Griess assay. Bacterial counts were determined by optical density at 600 nm. RESULTS: Gastric NO concentration was significantly lower in the critically ill group (102.7 ppb) compared with the control group (953.2 ppb), although this difference was abolished by treating the control group with omeprazole (54 ppb). Gastric nitrate and nitrite concentrations were similar in the control and ICU groups, suggesting that substrate deficiency was not a cause of the low intragastric NO. Gastric pH was significantly lower in the control subjects (3.0) compared with the ICU patients (6.3) and the control subjects after receiving omeprazole (6.5). ICU patients had a trend toward higher gastric bacterial load. CONCLUSION: In critically ill patients, markedly decreased NO concentrations are found in the gas of the stomach owing to a failure of gastric acidification.