Li Fang, Liu Hui, Zhang Luming, Huang Xiaxuan, Liu Yu, Li Boen, Xu Chao, Lyu Jun, Yin Haiyan
Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangdong, China.
Department of Intensive Care Unit, The Second Affiliated Hospital of Bengbu Medical College, Bengbu, China.
Front Pharmacol. 2022 May 5;13:898422. doi: 10.3389/fphar.2022.898422. eCollection 2022.
This study analyzed the association of gastric acid secretion inhibitors (GASIs) [including proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs)] with the occurrence of ventilator-associated pneumonia (VAP) and in-hospital mortality in patients who received invasive mechanical ventilation (IMV). Patients who received IMV and used GASI were included based on records in the MIMIC-IV database. The relationships of GASIs with VAP and the in-hospital mortality were determined using univariate and multivariate logistic regression analyses. Also, the effects of GASIs in some subgroups of the population were further analyzed. A total of 18,669 patients were enrolled, including 9191 patients on H2RAs only, 6921 patients on PPIs only, and 2557 were on a combination of the two drugs. Applying logistic regression to the univariate and multivariate models revealed that compared with H2RAs, PPIs had no significant effect on the incidence of VAP, and the combination of H2RAs and PPIs was a risk factor for VAP. Compared with H2RAs, univariate logistic regression revealed that, PPIs and combine the two drugs were both risk factors for in-hospital mortality, but multivariate logistic regression showed that they were not significantly associated with in-hospital mortality. In subgroup analysis, there were interaction in different subgroups of age, PCO2, myocardial infarct, congestive heart failure (P for interaction<0.05). Compared with H2RAs, PPIs did not have a significant association with either VAP or in-hospital mortality; the combination of H2RAs and PPIs was risk factor for VAP, but did not have a significantly associated with in-hospital mortality.
本研究分析了胃酸分泌抑制剂（GASI）[包括质子泵抑制剂（PPI）和组胺2受体拮抗剂（H2RA）]与接受有创机械通气（IMV）患者发生呼吸机相关性肺炎（VAP）及院内死亡率之间的关联。基于MIMIC-IV数据库中的记录，纳入接受IMV并使用GASI的患者。采用单因素和多因素逻辑回归分析确定GASI与VAP及院内死亡率之间的关系。此外，还进一步分析了GASI在部分人群亚组中的作用。共纳入18669例患者，其中仅使用H2RA的患者9191例，仅使用PPI的患者6921例，两种药物联合使用的患者2557例。对单因素和多因素模型应用逻辑回归分析显示，与H2RA相比，PPI对VAP发病率无显著影响，H2RA与PPI联合使用是VAP的危险因素。单因素逻辑回归分析显示，与H2RA相比，PPI及两种药物联合使用均是院内死亡的危险因素，但多因素逻辑回归分析显示，它们与院内死亡率无显著关联。亚组分析中，年龄、二氧化碳分压、心肌梗死、充血性心力衰竭等不同亚组间存在交互作用（交互作用P<0.05）。与H2RA相比，PPI与VAP及院内死亡率均无显著关联；H2RA与PPI联合使用是VAP的危险因素，但与院内死亡率无显著关联。
