The Use Of Omeprazole Affect The Incidence Of Ventilator Associated Pneumonia

Purpose:In order to observe different times after traumatic brain injury impact of omeprazole on mechanically ventilated ICU patients with ventilator-associated pneumonia(VAP) in the incidence. Method:Select the ICU after brain injury 120 patients need to receive mechanical ventilation, and all patients signed informed consent. According to the application of omeprazole time 120 patients were randomly according to figures randomly divided into four groups, namely the use of omeprazole(1 / d, 40 mg / d intravenously) 3d, 5d, 7d, 15 d. Patients in each group were extracted every 8h during gastric tube, precision application of p H measurement in patients with gastric p H test paper. In the beginning of the experiment left behind 3d once daily sputum and gastric juice, bacterial culture, while applying the test sub-pharyngeal throat bacteria cultured bacteria was observed. Observed in patients with lower respiratory tract pathogens VAP distribution.Result:1、omeprazole without the application time of each group in the comparison of age, the average age, sex, duration of mechanical ventilation, PEEP, APACHEII Glasgow Coma Scale score and other general information in, P> 0.05, the difference was not statistically significant, may participation in comparison.2、120 patients, a total of VAP49 cases occurred, the rate was 40.83%; among omeprazole 3d group VAP incidence 30.00%, 5d group was 36.67%, 7d group was 43.33%, 15 d group was 53.33%. Stress ulcer 13 cases there were 120 patients, the rate was 10.83%; 3d omeprazole group which stress ulcer incidence of 16.67%, 5d group was 16.67%, 7d group was 6.67%, 15 d group 3.33%. Compared with the first three groups, 15 d group differences in the incidence of VAP and stress ulcer was significantly(P <0.05).3、omeprazole application 3d Group gastric p H value 1.2 ± 0.7,5 d group was 2.6 ± 0.5,7 d group was 4.0 ± 0.8,15 d group was 5.3 ± 0.6; compared with the first three groups, 15 d group gastric p H changes in the value of the most significant(P <0.05);. shown in Table 3 were detected in 120 patients with gastric p H twice, a total of 240 cases of censorship gastric specimens, 147 specimens containing bacterial colonization, colonization rate was 61.25%. VAP gastric p H on the presence or absence of bacterial colonization of the stomach in patients with undifferentiated affect(P> 0.05). But VAP total number of 67 cases of colonization specimens, colonization rate was 68.37%; stomach in patients without VAP total number of 80 cases of bacterial colonization, colonization rate was 56.34%. The difference was significant(P <0.05).4、gastric p H> 4, with a maximum G-bacilli colonization, VAP group was 52.38% colonization, colonization without VAP group was 40.14%, the difference was significant(P <0.05); gastric p H ≤ 4, Up to Candida colonization, colonization rates of the two groups were 14.29%, there was no significant difference(P> 0.05).5、VAP pathogens detected in patients with gastric specimen 83, the detection rate was 84.69%; Candida, G+ cocci, G-bacteria, Enterobacter cloacae, Escherichia coli, mostly; pharyngeal swab specimens detected in 143 strains of pathogens strains, the detection rate was 145.92%; Candida, G+ cocci, G-bacteria, Acinetobacter baumannii, Pseudomonas aeruginosa majority. VAP in patients with oropharyngeal and detection of bacteria in the stomach Candida, G+ cocci, G-bacteria and Acinetobacter baumannii, Serratia, Enterobacter cloacae, Klebsiella significant difference(P <0.05).6、the lower respiratory tract in patients with VAP pathogens were detected 160 pathogens, Pseudomonas aeruginosa(27.50%), Staphylococcus aureus(16.25%), Acinetobacter baumannii(10.00%), Candida(10.00%) Klebsiella pneumoniae(6.88%) majority. Conclusion:1 、 ICU patients treated with mechanical ventilation, gastric p H increases, the incidence of stress ulcer reduction, increase the incidence of VAP.2、Gastric p H is an important factor affecting bacterial colonization of the stomach, VAP pathogens isolated from patients with Gram-negative bacilli in the majority, followed by phenotypic analysis of pathogenic bacteria infection route of the stomach cavity, oropharynx, lower respiratory tract, causing VAP.3、ICU patients receiving mechanical ventilation, use of omeprazole to maintain an appropriate time gastric p H was maintained at an appropriate level, can reduce the incidence of VAP decreased.