胃液酸度对重症监护病房人工气道患者胃内条件致病菌的影响  

Influence of gastric acidity on opportunistic pathogen growth in ICU： a direct study in patients with artificial airway

作　　者：冯永文[1] 吴明[1] 李颖[1] 曾晶晶[1] 李明利[1] 何云[1] 崔曼丽[1] 

机构地区：[1]深圳大学第一附属医院重症医学科,广东深圳518035

出　　处：《中国急救医学》2012年第5期434-436,共3页Chinese Journal of Critical Care Medicine

基　　金：广东省医学科研基金项目（No.A2010525）

摘　　要：目的 探讨重症监护病房人工气道患者胃液酸度和胃内条件致病菌的关系.方法 选择我院重症监护病房2008-12～2010-12收治的建立了人工气道〉48 h的80例重症患者,共收集107个胃液样本,用精密pH试纸测定胃液pH值,依胃液酸度将标本分为6组,同时做胃液细菌真菌培养.结果 ①107个胃液样本中有63个培养出细菌或真菌（58.8%）.63个胃液培养阳性的样本中共培养出96株细菌,其中G^- 菌、G^＋菌、真菌分别占49.9%、22.8%、27.2%.②Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ组胃液培养阳性率分别为0、25%、28.5%、62.5%、75%、81.8%.③我们发现在pH值为4时变化较大,重新将样本分成pH值≤4.0与pH值＞4.0两组,胃液培养阳性率分别为20%、74.0%,两组相比差异有统计学意义（χ^2=8.14,P〈0.01）.结论 建立了人工气道的重症患者胃液微生物培养主要以G^- 菌为主,随着胃液pH值的升高,培养阳性率明显升高,尤其是胃液pH值＞4时,培养阳性率高达60%以上.对于该类患者宜加强监测胃液pH值,防止胃内条件致病菌的定植.Objective To investigate the influence of gastric acidity on opportunistic pathogen of critically ill patients with artificial airway in intensive care unit （ICU）. Methods 80 patients （from December 2008 and December 2010） with artificial airway lasted longer than 48 hours were studied in ICU at the First Affiliated Hospital of Shenzhen University. After specimens of gastric juice were collected from patients, their pH values were measured by using precise pH papers. These samples were then classified into six groups according to their pH ranges, and were used to culture the bacterium or fungi and antibiotic susceptibility examinations. Results （1） 63 of 107 samples presented gastric bacterium and fungi （58.8%）, and 96 bacterium and fungi were cultured from 63 samples with 49.9% G^- ,22.8% G^＋ and 27.2% fungi respectively. （2） The rates of gastric culture in above six groups were 0, 25%, 28.5%, 62.5% ,75% and 81.8%. （3）Furthermore, these samples were also divided into two groups（pH ≤4.0 and pH 〉 4.0）by using statistical instrument. Since the positive rates of microbes culture in two groups were 20% and 74.0% respectively, there were statistical significances（Х^2 = 8.14, P 〈 0.01 ）. Conclusion Severe gastric microbes, mainly G^- bacteria, are cultured in artificial airway patients, and the positive rates of microbe culture are high with pH increases of patients＇ gastric juice, especially in the patients with pH value 〉 4, the positive rates of bacterial culture go up to 60%. We should pay attention to these patients by monitoring their gastric juice＇s pH value in order to protect them from stomach opportunistic pathogen.

关 键 词：重症监护病房 条件致病菌 胃液PH值 人工气道 

分 类 号：R655.3[医药卫生—外科学]