Yildizdas Dincer, Yapicioglu Hacer, Yilmaz Hayri Levent
Department of Pediatrics, Division of Neonatology, Cukurova University, Adana, Turkey.
J Crit Care. 2002 Dec;17(4):240-5. doi: 10.1053/jcrc.2002.36761.
The purpose of the study was to evaluate the effects of sucralfate, ranitidine, and omeprazole use on incidence of ventilatory-associated pneumonia (VAP) and mortality in ventilated pediatric critical care patients.
This prospective study was conducted at the pediatric intensive care unit (PICU) between August 2000 and February 2002. A total of 160 patients who needed mechanical ventilation were randomized into 4 groups according to the computer-generated random number table: group (S), (n = 38) received sucralfate suspension 60 mg/kg/d in 4 doses via the nasogastric tube that was flushed with 10 mL of sterile water; group (R), (n = 42) received ranitidine 2 mg/kg/d intravenously in 4 doses; group (O), (n = 38) received omeprazole 1 mg/kg/d intravenously in 2 doses; and group (P), (n = 42) did not receive any medication for stress ulcer prophylaxis. Treatment was begun within 6 hours of PICU admission.
Seventy patients (44%) developed VAP. VAP rate was 42% (16 of 38) in the sucralfate group, 48% (20 of 42) in the ranitidine group, 45% (17 of 38) in the omeprazole group, and 41% (17 of 42) in the nontreated group. Overall mortality rate was 22% (35 of 160); it was 21% (8 of 38) in the sucralfate group, 23% (10 of 42) in the ranitidine group, 21% (8 of 38) in the omeprazole group, and 21% (9 of 42) in the nontreated group. Our results did not show any difference in the incidence of VAP and mortality in mechanically ventilated PICU patients treated with ranitidine, omeprazole, or sucralfate, or nontreated subjects (P =.963, confidence interval [CI] = 0.958-0.968; P =.988, CI = 0.985-0.991, respectively). Nine patients (5.6%) had macroscopic bleeding. There was no statistically significant difference in macroscopic bleeding between groups.
Our results did not show any difference in the incidence of VAP, macroscopic stress ulcer bleeding, and mortality in the mechanically ventilated PICU patients treated with ranitidine, omeprazole, or sucralfate, or nontreated subjects. None of the treatment regimens increased VAP compared with the nontreated group. Because there is insufficient data about stress ulcer prophylaxis and VAP in the pediatric age group, more studies with larger numbers of patients are needed.
本研究旨在评估硫糖铝、雷尼替丁和奥美拉唑的使用对接受机械通气的儿科重症监护患者发生呼吸机相关性肺炎（VAP）的发生率及死亡率的影响。
本前瞻性研究于2000年8月至2002年2月在儿科重症监护病房（PICU）进行。共有160例需要机械通气的患者根据计算机生成的随机数字表随机分为4组：（S）组（n = 38）经鼻胃管给予硫糖铝混悬液60 mg/kg/d，分4次给药，每次给药后用10 mL无菌水冲洗胃管；（R）组（n = 42）静脉注射雷尼替丁2 mg/kg/d，分4次给药；（O）组（n = 38）静脉注射奥美拉唑1 mg/kg/d，分2次给药；（P）组（n = 42）未接受任何预防应激性溃疡的药物治疗。治疗在入住PICU后6小时内开始。
70例患者（44%）发生VAP。硫糖铝组VAP发生率为42%（38例中的16例），雷尼替丁组为48%（42例中的20例），奥美拉唑组为45%（38例中的17例），未治疗组为41%（42例中的17例）。总体死亡率为22%（160例中的35例）；硫糖铝组为21%（38例中的8例），雷尼替丁组为23%（42例中的10例），奥美拉唑组为21%（38例中的8例），未治疗组为21%（42例中的9例）。我们的结果显示，接受雷尼替丁、奥美拉唑或硫糖铝治疗的机械通气PICU患者与未治疗患者在VAP发生率和死亡率方面无差异（P = 0.963，置信区间[CI] = 0.958 - 0.968；P = 0.988，CI = 0.985 - 0.991）。9例患者（5.6%）出现肉眼可见的出血。各组之间肉眼可见出血情况无统计学显著差异。
我们的结果显示，接受雷尼替丁、奥美拉唑或硫糖铝治疗的机械通气PICU患者与未治疗患者在VAP发生率、肉眼可见的应激性溃疡出血及死亡率方面无差异。与未治疗组相比，各治疗方案均未增加VAP的发生率。由于儿科年龄组中关于应激性溃疡预防和VAP的资料不足，需要开展更多纳入更多患者的研究。
