Geroulanos S, Attinger B, Decurtins M, Buchmann P
Department of Chirurgie, Universitätsspital, Zürich.
Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1990:1063-8.
The incidence of pulmonary complications in patients with tracheal intubation is 17-25%. The mortality rate is considered to be between 50 and 81%. Aspiration of contaminated gastric fluid has been suggested to be a source of many of these complications. Gastric fluid contamination depends on the pH of the gastric fluid among other things. This results in a much higher incidence of nosocomial pneumonias in patients receiving H2-blockers (36%) or antacids and H2-blockers (38%) than placebo (8%) or sucralfate (10%). In contrast H2-blockers, antacids, omeprazole, pirenzepine and sucralfate show similar bleeding rates due to stress ulcers, but all are significantly lower than that of placebo. The routine application of prophylaxis for stress ulcer bleeding should nowadays be reserved for risk patients only. If necessary antimuscarinic drugs or sucralfate should be applied.
气管插管患者肺部并发症的发生率为17% - 25%。死亡率被认为在50%至81%之间。吸入受污染的胃液被认为是这些并发症中许多并发症的一个来源。胃液污染尤其取决于胃液的pH值。这导致接受H2受体阻滞剂(36%)或抗酸剂与H2受体阻滞剂联合使用(38%)的患者医院获得性肺炎的发生率比接受安慰剂(8%)或硫糖铝(10%)的患者高得多。相比之下,H2受体阻滞剂、抗酸剂、奥美拉唑、哌仑西平和硫糖铝因应激性溃疡导致的出血率相似,但均显著低于安慰剂。如今,应激性溃疡出血的预防性常规应用应仅保留给高危患者。如有必要,应使用抗胆碱能药物或硫糖铝。