Risk Factors And Rational Application Of Acid Inhibitor For Stroke-associated Pneumonia

Background and purpose:Stroke patients are susceptible to pneumonia,stroke associated pneumonia is one of the most common complications,and can significantly increased mortality and morbidity of patients after stroke is the main cause of illness and death in patients with cerebral apoplexy.Current clinical study found that the possibility of concurrent pneumonia after stroke is extremely high,if not detected early,positive and effective intervention treatment,will seriously affect the patient's quality of life,have increased pressure on society and family.Therefore,it is of great significance to look for the risk factors of pneumonia and timely intervene in the pneumonia after stroke,thus reducing the mortality of stroke.This paper explore the stroke pneumonia's influence factors and the related influencing factors of hospital operation treatment,to reduce unnecessary iatrogenic factors,further discusses the hospital drug treatment of risk factors for operation,analysis found that acid suppression agent as independent factors,and to explore the correlation of stroke pneumonia and acid suppression agent H2 receptor blockers(H2AR)and the application of proton pump inhibitors(PPI)relationship,for the understanding of the correlation of stroke pneumonia and to guide clinical rational drug use to provide the theoretical basis and data support.Methods:(1)Risk factors: this study randomly selected between December 2014 and December 2016 in our hospital neurologist 424 cases of cerebral apoplexy patients occurred during hospitalization,cases of patients with real-time monitoring and recording data,analysis of pneumonia clinically relevant risk factors of stroke.Mainly study the following factors: patients' gender,age,type of stroke,disturbance of consciousness(within 24 hours after admission GCS score nine points or less),swallowing dysfunction,bed,vomiting,smoking history,history of cardiac insufficiency,pulmonary disease history,diabetes history,nasal feeding,dehydrating agent,antibiotic therapy,treatment or acid treatment,etc.(2)The effect of acid inhibitor on related pneumonia: drug treatment at the same time,further randomly selected 295 cases of stroke patients without gastrointestinal bleeding,were randomly divided into 5 groups,test group A1 using H2 AR drugs cimetidine tablets,test group A2 used ranitidine H2 AR drugs capsules,test A3 group using PPI drugs panxi tora azole,test using PPI drugs prilosec A4 group,control group B did not use antiacid H2AR/PPI drug therapy.Statistical analysis of the incidence of apoplexy pneumonia and the distribution of pathogenic bacteria in patients.Results:(1)Risk factors: 424 stroke patients were included,a total of 141 cases of complicated by stroke associated pneumonia,the total infection rate was 33.3%;its influencing factors: age,type of stroke,disturbance of consciousness,swallowing dysfunction,always smoking history basis,cardiac insufficiency,pulmonary disease history,diabetes history,history of bed,hospital operation treatment: nasogastric treatment,acid inhibitors,etc.To influence the occurrence of stroke associated pneumonia,statistically significant difference between the two groups(all P<0.05).Multivariate analysis showed that consciousness disorder,dysphagia,vomiting,smoking history,history of stroke and antiacid therapy may be independent risk factors for stroke associated pneumonia.(2)Acid suppression and pneumonia correlation stroke: using acid suppression therapy were more likely to cause pneumonia correlation stroke unused acid suppression stroke patients,with statistical significance(P<0.05);The therapeutic use of PPI was higher than that of H2 RA,and the incidence of stroke was significantly increased with the duration of treatment.(3)Pathogenic bacteria: patients with sputum,oral mucosa,gastric juice training examination results show that the gram-negative bacteria as the main pathogenic bacteria,acid inhibitors used compared to not use the pathogenic bacteria more acid inhibitors,and sputum culture and gastric juice is bigger than the similarity of sputum cultivation and oral mucosa.Conclusions:(1)The occurrence of stroke associated pneumonia is the outcome of combined action of multiple factors,including the disturbance of consciousness,swallowing dysfunction,vomiting,smoking history,history of stroke,and acid suppression therapy may be an independent risk factor of stroke associated pneumonia.(2)The use of acid inhibitor can significantly increase the incidence of stroke associated pneumonia,increase the mortality of stroke patients,prolong the hospital stay,and use H2 RA drug therapy when necessary.(3)The pathogenic bacteria of pneumonia are mainly gram-negative bacteria,and the use of acid inhibitor can increase the pathogenic strain.