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Nosokomiale Lungeninfektionen. Epidemiologie und Problematik der Stressulkus-Prophylaxe

Epidemiology of Noscomial Pneumonia and Its Relation to Prophylaxis for Stress Ulcer Bleeding

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Deutsche Gesellschaft für Chirurgie

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Summary

The incidence of pulmonary complications in patients with tracheal intubation is 17–25%. The mortality rate is sonsidered to be between 50 and 81%. Aspiration of contaminated gastric fluid has been suggested to be a source of many of these complications. Gastric fluid contamination depends on the pH of the gastric fluid among other things. This results in a much higher incidence of nosocomial pneumonias in patients receiving H2-blockers (36%) or antacids and H2-blockers (38%) than placebo (8%) or sucralfate (10%). In contrast H2-blockers, antacids, omeprazole, pirenzepine and sucralfate show similar bleeding rates due to stress ulcers, but all are significantly lower than that of placebo.

The routine application of prophylaxis for stress ulcer bleeding should nowadays be reserved for risk patients only. If necessary antimuscarinic drugs or sucralfate should be applied.

Zusammenfassung

Die Inzidenz einer nosokomialen Pneumonie beim intubierten Patienten liegt bei 17–25%. Ihre Letalität schwankt zwischen 50–81%. Die Aspiration von kontaminiertem Magensaft scheint die häufigste Ursache zu sein. Magensaftkontamination ist wiederum vom Magen-pH abhängig, der bei einem pH von unter 3 eine Bakterienzahl 102/ml aufweist. Bei einem pH von 7 steigt die Bakterienzahl auf 108/ml. Durch Regurgitation, Besiedlung der oropharyngealen Mukosa und Mikro-Aspiration in die Trachea ist eine höhere Pneumonierate bei Antacida und H2-Blocker-Applikation (38%) oder einer Applikation von H2-Antagonisten allein (36%) festzustellen. Im Gegensatz dazu liegt die Pneumonierate bei Placebo (8%) oder Sucralfat-Applikation (10%) viel niedriger.

Durch die andersweilige Erniedrigung der Stressulcus-Blutung, sollte heutzutage eine Stressulcus-Prophylaxe nur bei Risikopatienten erfolgen. Weniger säuresuppremierende Mittel wie Antimuskarinika oder Sucralfat sollten den Vorzug genießen.

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Authors and Affiliations

  1. Department Chirurgie, Universitätsspital, CH-8091, Zürich, Schweiz

    S. Geroulanos, B. Attinger, M. Decurtins & P. Buchmann

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  1. S. Geroulanos
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  2. B. Attinger
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  3. M. Decurtins
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  4. P. Buchmann
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Editors and Affiliations

  1. Generalsekretär d. Deutschen Gesellschaft f. Chirurgie, Steinbacher Hohl 28, D-6000, Frankfurt a.M. 90, Deutschland

    E. Ungeheuer

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© 1990 Springer-Verlag Berlin Heidelberg

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Geroulanos, S., Attinger, B., Decurtins, M., Buchmann, P. (1990). Nosokomiale Lungeninfektionen. Epidemiologie und Problematik der Stressulkus-Prophylaxe. In: Ungeheuer, E. (eds) Deutsche Gesellschaft für Chirurgie. Langenbecks Archiv für Chirurgie Gegründet 1860 Kongreßorgan der Deutschen Gesellschaft für Chirurgie, vol 1990. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-48163-5_224

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  • DOI: https://doi.org/10.1007/978-3-642-48163-5_224

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-52926-2

  • Online ISBN: 978-3-642-48163-5

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