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Stress-related digestive tract mucosal disease is a common complication in pediatric intensive care unit(PICU). It may progress to stress ulcer and severe ulcer bleeding, which may lead to death.Currently, stress ulcer prophylaxis is recommended for critically ill children with high risk factors for stress ulcer, and the most commonly used acid suppression drugs are proton pump inhibitor and histamine-2 receptor antagonist.However, excessive prophylactic acid suppression is common and can increase the risk of hospital-acquired pneumonia and clostridium difficile infection in PICU.This review aimed to analyze the advantages and disadvantages of preventive acid suppressant therapy and promote the rational use of acid suppressant in PICU.
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In recent years， with the changes of people's life rhythm and living environment， the incidence of gastric ulcer has shown an increasing trend year by year， and the affected population has become younger and younger. In order to further explore the pathogenesis of gastric ulcer and its diagnosis and treatment methods， a variety of animal models of gastric ulcer have been established clinically， such as stress type， chemical factor type， pyloric ligation type， helicobacter infection type and disease-syndrome combination type. The authors intend to summarize the modeling methods and advantages and disadvantages of existing models on the basis of reviewing the etiology， pathogenesis and diagnostic criteria of gastric ulcers. It was found that the non-injurious stress method （restraint stress， restraint immersion stress and restraint freezing stress， etc.）+traditional Chinese medicine （TCM） syndrome modeling， acetic acid gavage method+TCM syndrome modeling were ideal choices for replicating animal models of acute and chronic gastric ulcer. At the same time， the analysis of the coincidence degree between each gastric ulcer model and the clinical disease characteristics of Chinese and western medicine showed that the coincidence degree of western medicine diagnostic criteria was higher than that of TCM diagnostic criteria. The successful judgment of the model was also based on western medicine diagnosis. In short， the model is insufficient in depth and breadth. It only detects a few core indicators and main indicators， ignoring the impact of secondary indicators on the diagnosis of the disease. There is also a big gap between the disease-syndrome combination model and the TCM clinical syndromes of this disease. Therefore， the depth and width of the model evaluation criteria should be strengthened， and the evaluation system of the disease-symptom combination model should be improved， in order to provide a more accurate reference for the replication of gastric ulcer models， and to replicate animal models of gastric ulcer with high coincidence degree of Chinese and western medicine for research purposes.
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Objective:To evaluate the effects and safety of stress ulcer prophylaxis (SUP) versus no prophylaxis in adult septic patients at risk of gastrointestinal bleeding (GIB).Methods:A retrospective cohort study was conducted, the data was extracted from Electronic Intensive Care Unit-Collaborative Research Database (eICU-CRD). All patients who received proton pump inhibitor (PPI) or H 2 receptor antagonist (H 2RA) or combined/sequential use for SUP within the first 48 hours of intensive care unit (ICU) admission were enrolled in the SUP group, those who did not received any SUP were enrolled in the non-SUP group. The differences of in-hospital mortality, length of ICU stay (LOS), the incidence of GIB and secondary infection complications between the two groups were compared. Propensity score matching (PSM) was conducted to balance the distributions of study variables between the two groups. Further subgroup analysis was performed according to whether SUP was used for more than 3 days. Multivariate Logistic regression analysis was conducted to analyze the factors influencing the outcome of GIB and secondary pneumonia. Results:A total of 11 413 patients were included in the final analysis, with 9 799 patients in SUP group and 1 614 in non-SUP group. A 1∶1 PSM created 1 600 patients in each cohort. ① Baseline characteristics: compared with SUP group, patients in non-SUP group were older [years old: 69.0 (56.0, 80.0) vs. 67.0 (56.0, 78.0)], acute physiology and chronic health evaluation Ⅳ (APACHEⅣ) score and sequential organ failure assessment (SOFA) score were significantly lower [APACHEⅣ score: 65 (50, 73) vs. 72 (58, 87), SOFA score: 5 (4, 7) vs. 7 (5, 9)], higher rates of underlying diseases such as hypertension and diabetes [hypertension: 15.6% (252/1 614) vs. 12.2% (1 196/9 779), diabetes: 4.5% (72/1 614) vs. 3.3% (325/9 779), both P < 0.05], indicating that patients in the SUP group were more severe. ② Comparison of clinical outcome: before PSM, SUP group had significantly higher in-hospital mortality [17.2% (1 688/9 799) vs. 10.9% (176/1 614)], longer LOS [days: 4.4 (2.9, 7.7) vs. 3.1 (2.5, 4.3)], and higher incidence of secondary pneumonia than non-SUP group [11.3% (1 112/9 799) vs. 6.8% (110/1 614)], with significant differences (all P < 0.05). There was no significant difference in the incidence of GIB and Clostridium difficile infection (CDI) between the two groups. After PSM, no significant differences were observed between the two groups with regard to in-hospital mortality, incidence of GIB and CDI. However, the SUP group had longer LOS [days: 3.9 (2.8, 6.6) vs. 3.1 (2.5, 4.3)], and higher incidence of secondary pneumonia [10.9% (174/1 600) vs. 6.8% (108/1 600)] compared with non-SUP group, the differences were statistically significant (all P < 0.05). Subgroup analysis showed that compared with SUP < 3 days group, patients in SUP ≥ 3 days group had higher disease severity score [APACHEⅣ score: 66 (51, 79) vs. 62 (48, 72), SOFA score: 6 (4, 8) vs. 5 (4, 7), both P < 0.05], in addition, patients in SUP≥3 days group had higher in-hospital mortality, incidence of GIB and secondary pneumonia (16.4% vs. 10.7%, 6.1% vs. 1.8%, 19.0% vs. 8.6%, respectively), and longer ICU LOS [days: 6.6 (4.1, 11.8) vs. 3.5 (2.6, 5.3), all P < 0.05]. ③ Multivariate Logistic regression analysis showed that SUP≥3 days group was associated with more GIB than that of non-SUP group [odds ratio ( OR) = 1.84, 95% confidence interval (95% CI) was 1.07-3.08, P = 0.030], and the incidence of GIB was less in SUP < 3 days group than that of non-SUP group ( OR = 0.57, 95% CI was 0.34-0.94, P = 0.020). When compared with non-SUP group, the risk of secondary pneumonia was increased both in SUP≥ 3 days group and SUP < 3 days group ( OR values were 2.95 and 1.34, 95% CI were 2.10-4.13 and 1.01-1.77, P values were < 0.001 and 0.040, respectively). Conclusion:Among critically ill adult patients with sepsis at risk for GIB, SUP showed no effect on reducing in-hospital mortality, the rate of GIB and CDI, but was associated with increased risk of secondary pneumonia and prolonged LOS.
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OBJECTIVE： To promote rational use of proton pump inhibitors （PPIs） during perioperative period. METHODS： PDCA （Plan， Do， Check， Action） cycle management was used， the irrational use of PPIs of 300 medical records in neurosurgery department of our hospital were collected. The reasons were analyzed， management target was formulated and measures were implemented. The effects of management were evaluated through comparing the rate of irrational drug use and ratio of irrational type of PPIs in 300 medical records of neurosurgery department during perioperative period after management. RESULTS： Through collecting related data to confirm risk factors of stress ulcer， establishing rationality evaluation criteria for perioperative prophylactic use of PPIs， conducting rational drug use training among medical staff， drawing up various management systems and strengthening supervision and management， the rate of irrational use of PPIs was decreased significantly in our hospital； the number of irrational drug use cases decreased from 240 before management to 156 after management， among which the rate of prophylactic drug use without indication decreased from 37.33％ to 29.00％ （P＜0.05）； the irrational dosage rate decreased from 11.33％ to 6.33％ （P＜0.05）； the rate of irrational dosing frequency dropped from 12.67％ to 5.00％ （P＜0.01）. CONCLUSIONS： PDCA cycle management of our hospital can standardize the prophylactic use of PPIs in neurosurgery department during perioperative period and promote rational use of PPIs.
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Objective To investigate the benefits and risks of stress ulcer prevention (SUP) using proton pump inhibitors (PPI) for critical patients. Methods The clinical data of adult critically ill patients admitted to the intensive care unit (ICU) of Northern Jiangsu People's Hospital from January 2016 to December 2018 were retrospectively analyzed. All patients who were treated with PPI for SUP within the first 48 hours after ICU admission were enrolled in the SUP group. Those who not received PPI were enrolled in the control group. A one-to-one propensity score matching (PSM) was performed to control for potential biases. The gender, age, underlying diseases, main diagnosis of ICU, drug use before ICU admission, sequential organ failure score (SOFA) at ICU admission, risk factors of stress ulcer (SU) and PPI usage were recorded. The end point was the incidence of gastrointestinal bleeding, hospital acquired pneumonia, Clostridium difficile infection and 30-day mortality. Kaplan-Meier survival curves were plotted, and survival analysis was performed using the log-rank test. Results 1 972 critical patients (788 in the SUP group and 1 184 in the control group) were enrolled, and each group enrolled 358 patients after PSM. Prior to PSM, compared with the control group, the SUP group had older patients, more underlying diseases, higher proportion of acute coronary syndrome (ACS), acute cerebrovascular disease, acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and poisoning in main diagnosis of ICU, more serious illness, and more risk factors of SU, indicating that ICU physicians were more likely to prescribe SUP for these patients. The incidence of gastrointestinal bleeding in the SUP group was significantly lower than that in the control group [1.8% (14/788) vs. 3.7% (44/1 184), P < 0.05], while the incidence of hospital acquired pneumonia and 30-day mortality were significantly higher than those in the control group [6.6% (52/788) vs. 3.5% (42/1 184), 17.9% (141/788) vs. 13.1% (155/1 184), both P < 0.01]. There was no significant difference in the incidence of Clostridium difficile infection between the SUP group and the control group [2.9% (23/788) vs. 1.8% (21/1 184), P >0.05]. After the propensity scores for age, underlying diseases, severity of illness and SU risk factors were matched, there was no significant difference in the incidence of gastrointestinal bleeding or 30-day mortality between the SUP group and the control group [2.2% (8/358) vs. 3.4% (12/358), 15.9% (57/358) vs. 13.7% (49/358), both P > 0.05], but the incidence of hospital acquired pneumonia in the SUP group was still significantly higher than that in the control group [6.7% (24/358) vs. 3.1% (11/358), P < 0.05]. Kaplan-Meier survival curve analysis showed that the 30-day cumulative survival rate of the SUP group was significantly lower than that of the control group before the PSM (log-rank test: χ2 = 9.224, P = 0.002). There was no significant difference in the 30-day cumulative survival rate between the two groups after PSM (log-rank test: χ2 = 0.773, P = 0.379). Conclusion For critical patients, the use of PPI for SUP could not significantly reduce the incidence of gastrointestinal bleeding and mortality, but increase the risk of hospital acquired pneumonia.
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Objective To analyze the use of proton pump inhibitors( PPIs) in the perioperative period of Zhoushan Hospital,thus to make appropriate management regulations for the clinical application of PPIs. Methods From September 2016 to October 2016,the use of PPIs in 614 surgical patients of Zhoushan Hospital were statistically analyzed. The rationality of the indications,drug use,drug administration,dosage,time,course of treatment,combined medication were analyzed. Results In 614 cases,there were 341 reasonable,unreasonable 273,the failure rate was 44. 46% (273/614). The main manifestations in the non indication of medication and medication course of treatment was too long. Conclusion There are many unreasonable phenomena in the course of clinical use of PPIs. Hospital and clinical pharmacists should strengthen supervision and management of the use of PPIs.
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Background: Intensive Care Unit is used to treat patients closer to their beds, in order to observe them more as distinct people to almost all the critically-ill patients.Methods: One hundred admitted patients in the ICU, 25 each sets of the patients observed their prophylactic management to prevent stress ulcer, pressure ulcer, UTI and chest infection, observations noted for the 7 days, directly by seeing and by cross-checked patient’s case-sheets.Results: There were 2 (8%) patients developed stress ulcer, 1 (4%) Catheter associated bacteriuria, 2 (8%) patients grade II pressure ulcer, and 5 (20%) patient’s done endotracheal intubation. All these 5 (20%) report of sputum culture found Ps. Aeruginosa, Klebsiella sensitive for Ceftriaxone + Sulbactum. The standard nursing care done by the on duty nursing staffs, i.e., no one given Ryle’s tube feeding for the stress ulcer cases, advised soft, palatable, non-spicy oral diet, Pressure ulcer’s 8% patients shifted on the air-bed mattress, ulcer’s cleaned with normal water soaked soft-napkin and applied sterile pad compressed dressing locally. For the ventilator in-situ patient’s, endotracheal tube cleaned 8-12 times within 12 hours. The Inbuilt Ventilator tube cleaned, and its filter changed and kept ready by the following standard aseptic precaution before using the ventilator. The chest physiotherapy was done by the chest medicine specialist of the all 5 ventilated patients. Prophylactic medication provided, i.e., Injection Pantoprazole 40mg once daily, Injection Ciprofloxacin 400mg twice daily, and Injection Inj. Ceftriaxone + Sulbactum gm 12 hourly interval administered daily.Conclusions: Standard nursing care was prime intervention as an Intensive Care Unit Prophylaxis along with Injection Pantoprazole 40mg once daily provided to prevent stress ulcer. Injection Ciprofloxacin 400mg twice daily provided to prevent Catheter Associated Bacteriuria. Injection Ceftriaxone + Sulbactum 1gm 12 hourly provided to prevent Ventilator Associate Pneumonia and pressure ulcer. Injection Ceftriaxone + Sulbactum 1gm 12 hourly interval. Intensive Care Unit’s Prophylactic measures helped to prevent further complication and reduced morbidity.
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Objective: To investigate the current situation of stress ulcer prevention in patients with orthopedic joint replacement in our hospital and explore the necessity of preventing bleeding of peptic ulcer in patients with hip/knee replacement. Methods: The ca-ses of hip/knee replacement discharged from our hospital in September 2017 were retrospectively analyzed. The age and gender of the patients were analyzed. The underlying medical conditions, the related laboratory indices and the uses of stress ulcer prevention drugs, analgesic and anticoagulation drugs were statistically analyzed. Results: A total of 109 cases were collected including 40 cases of hip replacement and 69 cases of knee replacement. The median of age was 63. The use rate of non-steroidal analgesic drugs was 98. 16% , that of deep venous thrombosis prevention drugs was 95. 4% , and that of stress ulcer prevention drugs was 67. 9% . No patient suffered from gastrointestinal bleeding. Conclusion: The majority of patients undergoing hip /knee replacement are the elderly, and the knee replacement patients are older with more operation duration and more bleeding during the hip replacement. Nonsteroidal anti-inflamma-tory drugs and the drugs for preventing deep venous thrombosis are widely used during perioperative period. At present, it is still uncer-tain whether the population needs regular prevention of stress ulcers. However, the combination of aspirin and NSAID is a risk factor. The other high-risk factors, as well as the necessity of prevention medication, still need to be investigated in a larger scale.
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Objective:To investigate the use of proton pump inhibitors (PPIs)in gynecological patients in a hospital and analyze the use rationality of PPIs for the prevention of stress ulcer so as to provide reference for the clinical application of PPIs. Methods:To-tally 1000 patients' medical records admitted to the gynecological department for the first time from January 1st to December 31st in 2016 were randomly selected to conduct a retrospective analysis,and the rationality of PPIs was evaluated. Results:The preventive use rate of PPIs was 90.72%(880/970). Among the 880 patients, 28.18%(248/880) of the patients were without indications for the preventive medication,95.68%(842/880) of the patients were with wrong administration time, and 91.46%(578/632) of the pa-tients were with wrong usage and dosage. Conclusion:When PPIs are used for the prevention of SU in gynecological surgery,irrational use such as without indications, unsuitable variety selection and wrong usage and dosage still exists. It is suggested that regulators should strengthen technical and administrative interventions and establish standard for the rational use of PPIs in hospitals so as to avoid the excessive use of PPIs and improve the situation of inappropriate application.
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Objective To determine non-thermal biological effect of low frequency pulsed electromagnetic field (LFPEF)on the stomach blood circulation and ultra microstructure of rat stress ulcer. Methods Thirty-six Sprague-Dawley rats were assigned to three equal groups:control,ulcer without interference group(UW)and ulcer exposure groups(UE).The rats stress ulcer models were constructed with the combination method of soak and bind in the low-pressure and hypoxia circumstance. Based on the singlechip,a LFPEF generator with adjustable frequency, amplitude and duty ratio was developed. Then the stomachs of the rats were exposed to the LFPEF generator 3 hours per day.On days 1,3,5 and 7,the blood circulation of the stomach was analyzed by the content of the serum NO and contrast ultrasonography.In addition,the ulcer tissue was taken out for section-staining. Finally, the pathological change of the stomach ultra microstructure was observed under a light microscope. Results On different days, the contents of the serum NO and microbubble concentration of UE group were significantly higher than those of the UW group(P<0.05). The pathological observation showed that the restoration of the gastric tissue in UE group was faster than that in the UW group(P<0.05).Conclusion LFPEF with certain proper parameter could improve the gastric tissue blood circulation and accelerate the stress ulcer restoration. [Chinese Medical Equipment Journal,2018,39(5):35-38]
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Objective To probe into the efficacy and safety of lowering the temperatures of enteral nutrition in severe craniocerebral injury patients to prevent stress ulcer,and provide reference for patients with severe craniocerebral injury to choose appropriate enteral nutrition temperature. Methods The clinical randomized controlled trial was adopted.Numbered the patients by the order of being hospitalized, then divided the 84 patients with severe craniocerebral injury who were receiving enteral nutrition into experimental group and control group with 42 cases each.The constant temperature in experimental group was 22 ℃, and that in control group was 38 ℃. Observed and compared regularly the pH levels, occult blood test of gastric juice and defecate of the two groups within 7 days. Results After different temperature enteral nutrition,pH value of gastric juice of patients at 1,4,7 days after enteral nutrition was 2.610.37,4.550.35,4.870.34 in experimental group,2.210.44,3.930.22,4.180.30 in control group,there was significant difference between two groups (t=3.856, 8.185, 8.322, all P<0.01). There was no significant difference between two groups in the positive rate of gastric occult blood test(x2=0.102,0.408, 1.332, all P>0.05). There was no significant difference in the incidence of diarrhea and diarrhea start time between two groups (x2=0.288, t=0.372, all P>0.05). Conclusions Lowering the temperature of enteral nutrition has a certain protective effect on the gastric mucosa of patients with severe craniocerebral injury,which is helpful to prevent the occurrence of stress ulcer,and does not increase the risk of diarrhea.
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Objective To determine the effects of non-thermal biological effect of low frequency pulsed electromagnetic field (LFPEF) with 15 Hz and 30 mT on ulcer wound during the plateau stress ulcer cure.Methods Thirty male Sprague-Dawley rats were assigned to three equal groups:control,normal cure group (NC) and exposure treatment groups (ET).The plateau rats stress ulcer models were constructed with the combination method of a hypoxic and low-pressure acclimation and the stimulation of absolute ethyl alcohol irrigating stomach.The LFPEF equipment generated the LFPEF of 15 Hz,40％ duty cycle and 30 mT to expose and treat the rats' stomach of ET group with the frequency of 3 hours each day.After 6 days of exposure treatment,the stress ulcer cure situation of each group was evaluated by the methods of macroscopic observation,the gastric juice pH values detection and ulcer index (UI) measurement.Results After 6 days of model,the macroscopic observation showed that the ulcer of NC group was worse than the that of ET group (P＜0.05).The pH values and UI of ET group were significantly different with those of NC group,and closed to those of the control group.Conclusion The nonthermal biological effect of LFPEF could promote the plateau stress ulcer cure.
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Objective:To investigate the clinical effects of stellate ganglion block(SGB) on the stress ulcer in burn patients and explore the underlying mechanisms.Methods:40 patients with burn injury induced stress ulcer were randomized to two groups:SGB group (n=20) and Control group (n=20).SGB group was treated with conventional symptomatic therapy,SGB group underwent SGB every two days for 1 week on the basis of Control group.And the levels of plasma ET-1 and NO were detected using ELISA before and after therapy.And the clinical efficacy of the two groups was observed after the treatment.Results:Compared with the Control group,the levels of plasma ET-1 and NO were markedly lower in the SGB group (P＜0.05),while the clinical efficacy was higher(P＜0.05).Conclusion:SGB could enhance the clinical efficacy stress ulcer in bum patients,which might be related to the decrease of plasma ET-1 and NO levels.
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Objective To investigate the efficacy of pantoprazole and omeprazole in the prevention of postoperative stress ulcer.MethodsThe patients were divided into control group (pantoprazole) and observation group (omeprazole) according to the random number table method from December 2015 to December 2016 in 200 cases of abdominal surgery.The incidence and adverse effects of stress ulcer were measured and the cost and effect were calculated.ResultsIn the observation group, the incidence of stress ulcer was 4.0% (4/100) in the observation group compared with 5.0% (5/100) in the control group(χ2=0.11, P=0.73).Compared with the control group, Both groups were treated with liver and kidney function and blood routine examination, no obvious abnormalities, and no significant adverse reactions during treatment.ConclusionAbdominal surgery patients with pantoprazole and omeprazole can effectively prevent postoperative stress ulcers, the cost of no significant difference, no significant adverse reactions.
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OBJECTIVE:To analyze the rationality of proton pump inhibitors (PPIs) in the prevention of stress ulcer in perioperative orthopedic patients of our hospitals,and to provide reference for ratioual use of PPIs in clinic.METHODS:The medical records of discharged orthopedic patients were selected during Jan.1st-30th in 2016.Those records were analyzed statistically in respects of the use of PPIs,general information of patients,operation situation,the stressors and risk factors of stress ulcer.The rationality of the use of PPIs was analyzed comprehensively.RESULTS:Among 664 surgical patients,PPIs were used in 210 cases,and H2 receptor antagonist (H2RA) were used in 74 cases,with prophylactic rate of 42.77％.The main types of operation were fracture fixation (74 cases,35.24％),discectomy and discectomy (38 cases,18.11％).Among 210 patients receiving PPIs,all of them used PPIs,among which 68 cases (32.38％) had no medication indications,128 cases (60.95％) were medication timing error,74 cases (35.24％) were administration frequency error and 44 cases (20.95％) were more than 3 d prophylactic drug use.CONCLUSION:When orthopedic patients use PPIs for the prevention of stress ulcer,there are serious irrational phenomena in indications,species selection,usage and dosage,treatment course and so on.Clinicians and regulators should pay great attention to it so as to avoid the excessive application of PPIs.
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Objective:To investigate the effect of early enteral nutrition on ventilator-associated pneumonia in patients with severe cerebrovascular disease,and to evaluate nutritional status,intestinal nutrition tolerance,pH value of gastric juice and incidence of gastrointestinal bleeding.Methods:This study was a prospective study.The subjects were 72 patients with severe cerebrovascular disease in the intensive care unit of Neurology Department of our hospital from March 2014 to May 2017.All patients were treated with nasal feeding and mechanical ventilation.Among them,36 patients received enteral nutrition support treatment within 24 hours (early group),and 36 patients received enteral nutrition support treatment after 24 hours (control group).The two groups were compared with the incidence of ventilator-associated pneumonia,weaning success rate,complications of enteral nutrition rate,and gastrointestinal bleeding within 7 days,serum albumin and serum prealbumin level after 7 days,survival rate after 28 days.We also analyzed the changes in pH of the gastric juice at admission,1 day,3 days,7 days,and 14 days after treatments.Results:In the early group,the incidence of ventilator-associated pneumonia,gastrointestinal bleeding,complications of enteral nutrition,were lower than the control group.The serum level of albumin and prealbumin,the rate of successful weaning and 28 day survival rate were higher than the control group.After the early enteral nutrition,the pH value of gastric juice increased significantly.Conclusion:Early application of enteral nutrition support therapy can improve the nutritional status of patients,reduce the incidence of ventilatorassociated pneumonia,improve the success rate of weaning,reduce the fatality rate and improve the prognosis of patients.Early enteral nutrition support treatment can also increase pH value of gastric juice and reduce the incidence of gastrointestinal complication and gastrointestinal bleeding.
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Objective To explore the evidence- based nursing measures of stress ulcer in children after gastrointestinal surgery. Methods The evidence-based individualized care was performed on 10 cases of children with stress ulcer after gastrointestinal surgery by reviewing the literature. Results Children with stress ulcers were cured, in stable condition, successfully evacuated from mechanical ventilation, and transferred to the general ward. Conclusions Based on the evidence-based nursing of stress ulcer in 10 children after gastrointestinal surgery, the evidence-based nursing was obtained, which can provide evidence for the future nursing of stress ulcer.
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Objective To establish the rat experimental animal model of plateau hypoxia caused stress ulcer.Methods Rats were randomly divided into the normoxia group,plateau hypoxia 2,4,6,8,10 d groups.Except the normoxia group,the rats in other groups were fed in a hypobaric chamber(simulated altitude 5000 m) for 2,4,6,8,10 d srespectively.Then the gastric mucosal ulcer index,gastric juice volume,pepsin activity and PH value of gastric juice were observed in each group.Results Different degrees of point-like and line-like bleeding,erosion and ulcer formation could be seen in rat gastric mucosa in the hypobaric chamber(simulated altitude 5 000 m) on 2,4,6,8,10 d of plateau hypoxia;the ulcer index was significantly increased;the PH value and gastric juice volume were significantly decreased and the pepsin activity was significantly elevated.The changes of various indexes were most obvious on 6 d of plateau hypoxia.Conclusion Rats fed in a hypobaric chamber simulating a altitude of 5 000 m for 2-10 d can eastablish the altitude hypoxia caused stress ulcer animal model,moreover the optimal time is 6 d.
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Proton pump inhibitors ( PPI) have been widely used in clinics because of strong and lasting inhibiting effect on gastric acid secretion. Because of the higher incidence of stress ulcer and more drug combination used in critical patients, the use of PPI is more important. It has been proved that PPI used in critical patients may increase the incidence of serious adverse events, such as clos-tridium difficile associated diarrhea and pneumonia, so the rational use of PPI is more important in critical patients, especially for the preventive use. The preventive use of PPI including the prevention of drug-related upper gastrointestinal damage and stress ulcer in crit-ical patients was reviewed in the paper in order to provide reference for the rational drug use.
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Objective To explore the evidence- based nursing measures of stress ulcer in children after gastrointestinal surgery. Methods The evidence-based individualized care was performed on 10 cases of children with stress ulcer after gastrointestinal surgery by reviewing the literature. Results Children with stress ulcers were cured, in stable condition, successfully evacuated from mechanical ventilation, and transferred to the general ward. Conclusions Based on the evidence-based nursing of stress ulcer in 10 children after gastrointestinal surgery, the evidence-based nursing was obtained, which can provide evidence for the future nursing of stress ulcer.