组胺2受体拮抗剂与静脉质子泵抑制剂在儿科重症监护病房的应用：胃pH值比较

Histamine 2 receptor antagonists vs intravenous proton pump inhibitors in a pediatric intensive care unit: a comparison of gastric pH.

作者信息

Tofil Nancy M, Benner Kim W, Fuller M Paige, Winkler Margaret K

机构信息

Division of Critical Care, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Al 35233, USA.

出版信息

J Crit Care. 2008 Sep;23(3):416-21. doi: 10.1016/j.jcrc.2007.10.038.

DOI:10.1016/j.jcrc.2007.10.038

PMID:18725049

Abstract

PURPOSE

The aim of this study was to assess gastric pH in critically ill pediatric patients receiving intravenous stress ulcer medication.

MATERIALS AND METHODS

A prospective study was done in 48 patients with a gastric tube in place who were receiving either ranitidine or a proton pump inhibitor and no enteral nutrition. Daily peak and trough gastric pHs were measured.

RESULTS

The median age was 7 years 5 months (range, 1 month to 19 years), the median weight was 31 kg (range, 3-130 kg), and the median pediatric risk of mortality 2 (PRISM2) score was 12.5 (range, 0-31). All patients were intubated and 8 received dialysis. The average trough pH was 4.4 +/- 1.6 in the ranitidine group, 4.9 +/- 1.8 in the once daily proton pump inhibitor group, and 5.0 +/- 1.2 in the twice daily proton pump inhibitor group (P = .16). The average peak pH was 5.3 +/- 1.8 in the ranitidine group, 5.9 +/- 1.6 in the once daily proton pump inhibitor group, and 6.0 +/- 1.0 in the twice daily proton pump inhibitor group (P = .06). Three (10%) of 28 trough pH measurements in the twice daily proton pump inhibitor group were more acidic than 4 vs 24 (40%) of 60 in the ranitidine group, and 22 (40%) of 56 in the once daily proton pump inhibitor group (P = .02). One (4%) of 27 peak pH measurements in the twice daily proton pump inhibitor group were more acidic than 4 vs 13 (20%) of 61 in the ranitidine group, and 9 (16%) of 56 in the once daily proton pump inhibitor group (P = .12). Three patients (6%; 95% confidence interval, 0.51%-16%) developed upper gastrointestinal bleeding, and 4 patients (8%; 95% confidence interval, 0%-13%) developed ventilator-acquired pneumonia.

CONCLUSIONS

Many critically ill pediatric patients receiving stress ulcer prophylaxis have a trough or peak gastric pH more acidic than 4.

摘要

目的

本研究旨在评估接受静脉应激性溃疡药物治疗的危重症儿科患者的胃内pH值。

材料与方法

对48例留置胃管、正在接受雷尼替丁或质子泵抑制剂治疗且未接受肠内营养的患者进行了一项前瞻性研究。每日测量胃内pH值的峰值和谷值。

结果

中位年龄为7岁5个月（范围1个月至19岁），中位体重为31 kg（范围3 - 130 kg），儿科死亡风险2（PRISM2）评分中位数为12.5（范围0 - 31）。所有患者均已插管，8例接受透析治疗。雷尼替丁组的平均谷值pH为4.4±1.6，每日一次质子泵抑制剂组为4.9±1.8，每日两次质子泵抑制剂组为5.0±1.2（P = 0.16）。雷尼替丁组的平均峰值pH为5.3±1.8，每日一次质子泵抑制剂组为5.9±1.6，每日两次质子泵抑制剂组为6.0±1.0（P = 0.06）。每日两次质子泵抑制剂组28次谷值pH测量中有3次（10%）低于4，雷尼替丁组60次中有24次（40%），每日一次质子泵抑制剂组56次中有22次（40%）（P = 0.02）。每日两次质子泵抑制剂组27次峰值pH测量中有1次（4%）低于4，雷尼替丁组61次中有13次（20%），每日一次质子泵抑制剂组56次中有9次（16%）（P = 0.12）。3例患者（6%；95%置信区间，0.51% - 16%）发生上消化道出血，4例患者（8%；95%置信区间，0% - 13%）发生呼吸机相关性肺炎。