本文選題：奧美拉唑　切入點(diǎn)：不同應(yīng)用時(shí)間　出處：《泰山醫(yī)學(xué)院》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:觀察顱腦外傷術(shù)后不同時(shí)間使用奧美拉唑?qū)CU機(jī)械通氣患者呼吸機(jī)相關(guān)肺炎(VAP)的發(fā)生率的影響。方法:選取ICU中顱腦外傷術(shù)后需接受機(jī)械通氣的患者120例,所有患者均簽署知情同意書(shū)。根據(jù)奧美拉唑的應(yīng)用時(shí)間將120例患者根據(jù)數(shù)字隨機(jī)表法隨機(jī)分為4組,分別為使用奧美拉唑(1次/d,40mg/d靜脈滴注)3d、5d、7d、15d。各組患者均每隔8h抽取胃管內(nèi)胃液,應(yīng)用p H精密試紙測(cè)定患者胃液p H值。在實(shí)驗(yàn)開(kāi)始后頭3d每日留一次痰及胃液,進(jìn)行細(xì)菌培養(yǎng),同時(shí)應(yīng)用咽試子病菌培養(yǎng)觀察咽喉部位的病菌。同時(shí)觀察VAP患者下呼吸道病原菌分布。結(jié)果:1、奧美拉唑不用應(yīng)用時(shí)間各組在年齡、平均年齡、性別、機(jī)械通氣時(shí)間、PEEP、APACHEII評(píng)分及格拉斯哥昏迷評(píng)分等一般資料的比較中,P值0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義,可參與比較。2、120例患者中,共發(fā)生VAP49例,發(fā)生率為40.83%;其中奧美拉唑3d組VAP發(fā)生率為30.00%、5d組為36.67%、7d組為43.33%、15d組為53.33%。120例患者共發(fā)生應(yīng)激性潰瘍13例,發(fā)生率為10.83%;其中奧美拉唑3d組應(yīng)激性潰瘍的發(fā)生率為16.67%、5d組為16.67%、7d組為6.67%、15d組為3.33%。與前三組相比,15d組在VAP及應(yīng)激性潰瘍的發(fā)生率方面差異顯著(P0.05)。3、奧美拉唑應(yīng)用3d組胃液p H值為1.2±0.7,5d組為2.6±0.5,7d組為4.0±0.8,15d組則為5.3±0.6;與前三組相比,15d組胃液p H值變化最為顯著(P0.05);詳見(jiàn)表3。120例患者共檢測(cè)胃液p H值兩次,送檢胃液標(biāo)本共計(jì)240例,其中147例標(biāo)本中含有定植菌,定植率為61.25%。胃液p H值對(duì)有無(wú)VAP的患者的胃內(nèi)定植菌無(wú)差別影響(P0.05)。但VAP總定植標(biāo)本數(shù)為67例,定植率為68.37%;無(wú)VAP的患者胃內(nèi)總定植菌數(shù)為80例,定植率為56.34%。兩組差異顯著(P0.05)。4、胃液p H值4時(shí),以G-桿菌定植最多,VAP組定植率為52.38%、無(wú)VAP組定植率為40.14%,兩組差異顯著(P0.05);胃液p H值≤4時(shí),以念珠菌定植最多,兩組定植率均為14.29%,兩組無(wú)顯著差異(P0.05)。5、經(jīng)標(biāo)本分離后可知,VAP患者經(jīng)胃液標(biāo)本檢出病原菌83株,檢出率為84.69%;以念珠菌、G+球菌、G-球菌、陰溝腸桿菌、大腸埃希菌居多;咽試子標(biāo)本檢出病原菌株143株,檢出率為145.92%;以念珠菌、G+球菌、G-球菌、鮑曼不動(dòng)桿菌、銅綠假單胞菌居多。VAP患者口咽部及胃內(nèi)的檢出菌以念珠菌、G+球菌、G-球菌以及鮑曼不動(dòng)桿菌、沙雷菌、陰溝腸桿菌、克雷伯桿菌差異顯著(P0.05)。6、VAP患者下呼吸道病菌共檢出160株病原菌,以銅綠假單胞菌(27.50%)、金黃色葡萄球菌(16.25%)、鮑曼不動(dòng)桿菌(10.00%)、念珠菌(10.00%)、肺炎克雷伯菌(6.88%)居多。結(jié)論:ICU患者行機(jī)械通氣治療時(shí),隨著胃液p H值增加,應(yīng)激性潰瘍的發(fā)生率降低、VAP發(fā)生率增加。1、胃液p H值是影響胃內(nèi)定植菌的重要因素,VAP患者分離的病原菌以革蘭氏陰性桿菌居多,通過(guò)對(duì)病原菌的表型分析后病原菌感染途徑為胃腔、口咽部、下呼吸道,從而引起VAP。2、對(duì)于ICU機(jī)械通氣患者,使用適當(dāng)時(shí)間的奧美拉唑能夠保持胃液p H維持在適當(dāng)程度,可降低VAP發(fā)生率。
[Abstract]:Objective: to observe the effect of omeprazole on the incidence of ventilator-associated pneumonia (VAP) in patients with ICU after craniocerebral trauma. According to the time of omeprazole's application, 120 patients were randomly divided into 4 groups according to the method of digital random list. Each group was treated with omeprazole 40 mg / d intravenously for 3 days, 5 days, 7 days and 15 days. The gastric juice was extracted every 8 hours in each group. The pH value of gastric juice was measured with pH precision test paper. Sputum and gastric juice were left once a day for bacterial culture in the first three days after the beginning of the experiment. At the same time, the germs in throat were observed by using pharynx test bacteria culture, and the distribution of pathogens in lower respiratory tract of patients with VAP was also observed. Results: 1, omeprazole did not need to be used in each group in age, average age, sex, etc. There was no significant difference in the mean time of mechanical ventilation (P 0.05) between PEEPV Apache II score and Glasgow coma score. There was no significant difference between them. VAP49 was found in 120 patients who could take part in the comparison of PEEPN and Glasgow coma score. The incidence of VAP in omeprazole 3d group was 30.005d, and the incidence rate of omeprazole 36.67D group was 43.333.330.120 cases of stress ulcer was found in Omeprazole 3d group, 53.330.120 cases in Omeprazole group, 36.67D group, 53.330.120 cases in 15 d group, there were 13 cases of stress ulcer. The incidence of stress ulcer in omeprazole group was 16.67 days, 16.67 days after treatment, and 6.67g / 15d group (P < 0.05). The incidence of stress ulcer in omeprazole group was significantly higher than that in the first three groups (P 0.05. 3). The gastric juice of omeprazole group was treated with omeprazole for 3 days group, compared with the first three groups, the incidence rate of stress ulcer in the 15 day group was significantly higher than that in the control group (P < 0. 05. 3). The incidence of stress ulcer in omeprazole group was 16. 67 days. The pH value of gastric juice in group A (1.2 鹵0.7d) was 2.6 鹵0.5d (4.0 鹵0.815d), and that in group B (5.3 鹵0.6d) was 5.3 鹵0.6.The pH value of gastric juice in 15d group was the most significant than that in group 鈪，

本文編號(hào)：1592359