Thomason M H, Payseur E S, Hakenewerth A M, Norton H J, Mehta B, Reeves T R, Moore-Swartz M W, Robbins P I
Department of General Surgery, Carolinas Medical Center, Charlotte, North Carolina 28232-2861, USA.
J Trauma. 1996 Sep;41(3):503-8. doi: 10.1097/00005373-199609000-00020.
To compare the incidence of nosocomial pneumonia in critically injured patients randomized to one of three stress ulcer prophylaxis regimens.
Prospective, randomized clinical trial.
Mechanically ventilated patients admitted to the trauma intensive care unit of a Level I trauma center received sucralfate, antacid, or ranitidine.
Two hundred forty-two patients were randomized: sucralfate, n = 80; antacid, n = 82; and ranitidine, n = 80. There was no statistically significant difference in pneumonia rates among the treatment groups (p = 0.875). Pneumonia occurred more frequently in patients with gram-negative retrograde colonization from stomach to trachea (p = 0.02), but this accounted for only 13% of all pneumonias in the study population. The death rate in patients with pneumonia was not statistically different among the three groups. Although 20% developed overt gastrointestinal bleeding, no episode was clinically significant. Mean gastric pH was > 4 in 95% of the study population, including 88% of patients receiving sucralfate. The death rate in the antacid group was significantly higher (p = 0.046) but not because of increased gastrointestinal bleeding or pneumonia.
Our results show no difference in the incidence of nosocomial pneumonia in mechanically ventilated trauma patients during the first 4 days of stress ulcer prophylaxis with sucralfate, antacid, or ranitidine. There is a trend toward decreased pneumonia in the sucralfate group after study day 4. Even after controlling for injury severity, the mortality rate in the antacid group was significantly higher; the reasons for this are unknown.
比较随机接受三种应激性溃疡预防方案之一的重伤患者医院获得性肺炎的发生率。
前瞻性随机临床试验。
入住一级创伤中心创伤重症监护病房的机械通气患者接受硫糖铝、抗酸剂或雷尼替丁治疗。
242例患者被随机分组：硫糖铝组，n = 80；抗酸剂组，n = 82；雷尼替丁组，n = 80。各治疗组之间的肺炎发生率无统计学显著差异（p = 0.875）。胃至气管革兰氏阴性逆行定植的患者肺炎发生率更高（p = 0.02），但这仅占研究人群中所有肺炎病例的13%。三组中肺炎患者的死亡率无统计学差异。虽然20%的患者出现明显的胃肠道出血，但无临床显著事件。95%的研究人群平均胃pH值> 4，包括88%接受硫糖铝治疗的患者。抗酸剂组的死亡率显著更高（p = 0.046），但并非由于胃肠道出血或肺炎增加所致。
我们的结果表明，在使用硫糖铝、抗酸剂或雷尼替丁进行应激性溃疡预防的前4天，机械通气创伤患者医院获得性肺炎的发生率无差异。研究第4天后硫糖铝组肺炎有下降趋势。即使在控制损伤严重程度后，抗酸剂组的死亡率仍显著更高；其原因尚不清楚。
