心脏病患者胃液pH值监测对预防呼吸机相关性肺炎的作用研究  

Effect of Gastric Juice pH Value Monitoring in Patients with Heart Disease on Preventing Ventilator-Associated Pneumonia

作　　者：曹晓晴[1] 徐德臻[2] 卢桂兰 李伟[2] Cao Xiao-qing;Xu De-zhen;Lu Gui-lan;Li Wei(Obstetric LDR Ward,Binzhou Medical University Hospital,Binzhou 256600,Shandong Province,China;Department of Cardiovascular Surgery,Binzhou Medical University Hospital,Binzhou 256600,Shandong Province,China;Department of Oncology,Binzhou Medical University Hospital,Binzhou 256600,Shandong Province,China)

机构地区：[1]滨州医学院附属医院产科LDR病区,山东滨州256600 [2]滨州医学院附属医院心脏大血管外科,山东滨州256600 [3]滨州医学院附属医院肿瘤科,山东滨州256600

出　　处：《中国社区医师》2022年第29期88-90,共3页Chinese Community Doctors

基　　金：滨州医学院科研计划基金项目:(BY2017KJ36)。

摘　　要：目的:通过观察心脏病患者术后抑酸药物使用的规律与胃液pH值水平,分析pH值与呼吸机相关性肺炎(VAP)的关系。方法:将2017年1月-2022年1月收治的75例气管插管或气管切开行机械通气>48 h的心脏病患者作为研究对象,患者按照服用抑酸药物种类不同分为奥美拉唑组、西咪替丁组、莫沙必利组,各25例。三组患者在用药前和服药48 h后抽取胃液,检测胃液pH值,进行胃液细菌培养,同时采集呼吸道分泌物进行细菌培养。结果:三组患者用药后胃液pH值均升高,与用药前比较差异具有统计学意义(P<0.01)。用药48 h后奥美拉唑组患者发生VAP的概率为12.0%,西咪替丁组为8.0%,莫沙必利组为4.0%。通过对患者胃液和呼吸道细菌进行分离鉴定,其中胃液中的细菌主要为铜绿假单胞菌、鲍曼不动杆菌、埃希大肠杆菌、克雷伯杆菌,呼吸道细菌主要为铜绿假单胞菌、鲍曼不动杆菌和阴沟肠杆菌。胃液中的细菌与下呼吸道优势菌具有同源性。结论:在使用不同抑酸药物情况下体内pH值升高,患者pH值越高则患VAP的概率越大。所以心脏病患者术后对其进行抑酸药物的指导使用,能够控制胃液的pH值,降低VAP发生率。Objective:To analyze the relationship between pH value and ventilator-associated pneumonia(VAP)by exploring the use law of acid-suppressing drugs and pH value of gastric juice in patients with heart disease after surgery.Methods:From January 2017 to January 2020,75 patients with heart disease who received endotracheal intubation or tracheotomy for mechanical ventilation for more than 48 hours were selected as the research objects.They were divided into omeprazole group,cimetidine group and mosapride group depending on the type of acid-suppressing drug taken,with 25 cases in each group.Before administration and after 48 hours of administration,gastric juice was collected to monitor the pH value and perform bacterial culture.At the same time,respiratory secretions were collected for bacterial culture.Results:The pH value of gastric juice increased in the three groups after treatment,which was statistically significant compared with that before treatment(P<0.01).After 48 hours of administration,the probability of VAP was 12.0%in the omeprazole group,8.0%in the cimetidine group,and 4.0%in the mosapride group.By isolating and identifying gastric juice and respiratory tract bacteria,the bacteria in gastric juice were mainly Pseudomonas aeruginosa,Acinetobacter baumannii,Escherichia coli,Klebsiella,and the bacteria in the respiratory tract were mainly Pseudomonas aeruginosa,Acinetobacter baumannii and Enterobacter cloumatis.The bacteria in gastric juice and the dominant bacteria in the lower respiratory tract had the homology.Conclusion:Under the condition of using different acidsuppressing drugs,the pH value in vivo increases,and the higher pH value of the patient is associated with the greater probability of VAP.Therefore,the guidance on the use of acid-suppressing drugs after surgery for heart disease patients can control the pH value of gastric juice and reduce the incidence of VAP.

关 键 词：心脏病 呼吸机相关性肺炎 PH值 

分 类 号：R654.2[医药卫生—外科学] R563.1[医药卫生—临床医学]