脑损害昏迷患者上消化道出血的预防

目的 探讨脑损害昏迷患者上消化道出血的发病因素和预防措施。方法 对274例脑损害昏迷患者，分析其并发上消化道出血的内环境因素和预防效果。结果 并发上消化道出血49例，占17.9%，而在ICU条件下早期鼻饲西沙必利、奥美拉唑及氢氧化铝凝胶预防组消化道出血的发生率为40%(2/50)；伤后休克低血压、低氧血症、低钠血症、氮质血症、酸中毒、高血糖、高脂质过氧化水平均可增加上消化道出血的发生率。结论 ICU条件下维护内环境平衡、早期鼻饲、胃肠动力及抑酸药物应用，可显著关注脑损害昏迷患者上消化道出血的发生。

The prevention of upper gastrointestinal bleeding following coma of brain damage

Objective To study the pathogenesis and prevention of upper gastrointestinal bleeding (UGB) in unconscious patients with brain damage. Methods Predisposing factors and prevention measures on UGB in unconscious patients with brain damage during the last 5 years were analyzed retrospectively. Results There were 49 UGB out of 274 cases of unconscious patients with brain damage. The incidence of UGB was 17.9%. Intensive care, early nasal feeding, prepulsid, losec and aluminum hydroxide gel reduced the incidence of UGB significantly to 4 0% (2/50, P < 0.005). But the incidence of UGB markedly increased in patients with hypotension, hypoxemia, hyponatremia, azotemia, acidosis, hyperglycemia and high MDA state following brain damage. Conclusion Intensive care, maintaining homestasis, early nasal feeding, enhancing gastro-intestinal motility and inhibiting gastric acid secretion may maximally reduce the incidence of UGB in unconscious patients with brain damage.