加護病房胃酸抑制藥物使用與發生院內感染型肺炎危險之相關性探討   全文下載

Risk for Hospital-Acquired Pneumonia from Proton Pump Inhibitor or Sucralfate in Intensive Care Units

使用氫離子幫浦抑制劑（PPI）可能增加病人發生院內感染型肺炎 （HAP）之風險，本研究的目的為探討重症病人使用PPI或sucralfate發生HAP的危險。以回溯性觀察世代研究，比較加護病房病人使用PPI或sucral-fate預防壓力性潰瘍時，HAP的發生率。運用傾向分數與其他危險因子計算兩組調整後之勝算比。研究共納入388位病人，PPI組為302人，sucralfate組86人。結果顯示PPI組有63位病人感染肺炎，發生率為20.86%；而sucralfate組發生肺部感染則為8人，發生率為9.30%。因此與sucralfate相較下，使用PPI發生HAP的危險較高（adjusted odds ratio 3.37, 95% CI 1.35-8.45, p= 0.009）。當病人使用PPI且APACHE II分數大於13分（adjusted OR 3.70, 95% CI 1.04-13.10, p=0.043），或使用PPI同時加護病房的住院天數＞8天時（adjusted odds ratio 9.04, 95% CI 1.94-42.06, p =0.005），則發生HAP的風險最高。內科加護病房的病人使用PPI相較於sucralfate，發生HAP的風險較高；因此可考慮使用sucralfate作為預防壓力性潰瘍的藥物。而入住加護病房的時間延長或APACHE II分數較高時，使用PPI應權衡治療的利益和風險。"

The increased risk of pneumonia from proton pump inhibitors (PPI) has been addressed in recent studies. This study aimed to inves-tigate the risk of hospital-acquired pneumonia (HAP) in critically ill patients receiving PPI or sucralfate. This retrospective observational cohort study analyzed patients who were prescribed with PPIs or sucralfate for stress ulcer prophylaxis in intensive care units (ICU). A propensity score and other risk factors were used to calculate the adjusted odds ratio (OR) for the two groups. The final cohort comprised 388 patients with 302 patients on PPI and 86 patients on sucralfate therapies. HAP developed in 63 patients (20.86%) on PPI, and 8 patients (9.30%) on sucralfate (adjusted OR 3.37, 95% CI 1.35-8.45, p-value 0.009). The enrolled patients on PPI therapy with an APACHE II score > 13 (adjusted OR 3.70, 95% CI 1.04-13.10, p-value 0.043), or those on PPI therapy with an ICU stay of more than 8 days (adjusted OR 9.04, 95% CI 1.94-42.06, p-value 0.005) had the highest risk of developing HAP. Patients in medical ICU treated with PPIs had a higher risk of developing HAP than those treated with sucralfate. For the ICU patients requiring stress ulcer prophylaxis, sucralfate can be considered as a priority treatment. The risk and benefit of PPI treatment should be evaluated for patients who may have a longer ICU stay or have a high APACHE II score.