抑酸药对后循环急性脑梗死患者发生肺部感染的影响

目的探讨抑酸药对后循环急性脑梗死患者肺部感染和急性胃黏膜病变发生的影响,及抑酸药物的合理使用。方法回顾性分析2010年07月至2015年12月在我院神经内科住院确诊为急性脑梗死的患者350例,年龄大于18岁,均经头颅MR检查明确为后循环急性脑梗死,所有患者均于发病48 h内入院,且入院前无发热、咳痰等肺部感染临床症状,血白细胞无明显升高或降低,肺部影像学无新发改变,且无急性胃黏膜病变的临床表现;根据入院后是否预防性使用质子泵抑制剂类抑酸药,将其分为使用抑酸药组及非使用抑酸药组,均衡性别、年龄、糖尿病史、冠心病、意识障碍、吞咽障碍、肺部疾病、高血压、慢性胃部疾病史等组间因素后,分析有无抑酸药物使用对急性脑梗死肺部感染发生率及急性胃黏膜病变发生率的影响,将数据进行统计学分析,评价抑酸药物对急性脑梗死患者的影响。结果 350例患者平均年龄72.3岁,其中男性210例占60%,女性140例占40%;抑酸药组男性92例,女性68例,占45.7%,平均年龄73.5岁;非抑酸药组男性118例,女性72例,占54.3%,平均年龄71.2岁;350例患者中发生肺部感染94例,总的肺部感染率为26.8%,其中男性67例占71.3%,女性27例占28.7%;使用抑酸药组发生肺部感染56例,感染率35.0%,非抑酸药组肺部感染38例,感染率20.0%,两组间肺部感染发生率的差别有统计学意义;意识障碍患者中有63例发生肺部感染,占意识障碍总人数的66.3%;吞咽困难无意识障碍患者中有28例发生肺部感染,占吞咽困难总人数的44.5%;发生急性胃黏膜病变共81例,发生率为23.1%,其中抑酸药组29例,非抑酸药组52例,两组间急性胃黏膜病变发生率有统计学意义;共53例有慢性胃部疾病史,其中抑酸药组25例,发生急性胃黏膜病变5例,非抑酸药组28例,有13例发生急性胃黏膜病变,差异有统计学意义。结论后循环急性脑梗死患者预防性使用抑酸药会明显增加卒中后肺部感染的发生,使用抑酸药组的急性胃黏膜病变发生率低于未用药组,提示对患者进行危险分层评估后再确定是否预防性使用抑酸药,方可得到最佳效果。

Effects of acid suppressive drugs on common complications in patients with posterior circulation acute cerebral infarction

Objective To investigate the effect of acid suppressive drugs on pulmonary infection and acute gastric mucosal lesion in patients with acute cerebral infarction.Methods A retrospective analysis 350 cases from July 2010 to December 2015 in the Department of Neurology of our hospital, which diagnosed acute cerebral infarction patients, older than 18 years, were examined by MR examination of posterior circulation acute cerebral infarction.All the patients were admitted within 48 hours of onset, and before admission, no fever, sputum and other symptoms of pulmonary infection, obviously no increase or decrease of white blood cell, lung imaging and no new changes, and no clinical manifestations of acute gastric mucosal lesions after admission.According to whether the preventive use of proton pump inhibitors of acid inhibitory drugs, which were divided into the use of acid suppressive medication group and non use of acid suppressive drug group.The sex, age, diabetes the history of coronary heart disease, disorder of consciousness, dysphagia, lung disease, hypertension, history of chronic disease were balanced, analysis of whether the use of acid suppressive drugs on acute cerebral infarction, the incidence of pulmonary infection and acute gastric mucosal lesions.The data were statistically analyzed to evaluate the effect of acid suppression drugs on patients with acute cerebral infarction.Results The mean age of the 350 patients was 72.3 years, male 210 cases accounted for 60％, female 140 cases accounted for 40％.There were 92 male and 68 female patients in the anti acid group, accounting for 45.7％, with an average age of 73.5 years.There were 118 males and 72 females in non acid drug group, accounting for 54.3％, with an average age of 71.2 years.94 cases had pulmonary infection, and the total infection rate was 26.8％ in all of the 350 patients;Male 67 cases accounted for 71.3％, Female 27 cases accounted for 28.7％;There were 56 cases of pulmonary infection in acid suppressive group, the infection rate was 35％, 38 cases of lung infection in the non acid drug group, the infection rate was 20％;The incidence of pulmonary infection between the two groups was statistically significant.There were 63 cases of pulmonary infection in patients with consciousness disorder, accounting for 66.3％.28 patients with dysphagia had pulmonary infection, accounting for about 44.5％.There were 81 cases of acute gastric mucosal lesions, the incidence of which was about 23.1％, of which there were acid suppression group (n=29) and non acid suppression group (n=52).There was statistical significance between the two groups.A total of 53 patients had a history of chronic gastric diseases, among which, there were 25 cases of anti acid drugs, and 5 cases of acute gastric mucosal lesions occurred;There were 28 cases of non acid drug group, and 13 cases of acute gastric mucosal lesions;The difference was statistically significant.Conclusions The use of acid suppressive drugs will obviously increase after the cycle of pulmonary infection in acute cerebral infarction patients with acute gastric mucosal lesions, acid suppression drug group was lower than the control group.The patients were evaluated by the risk stratification, and then the best results were obtained by the use of acid suppressing drugs.