The aim of the study was to determine the optimal method of gastric stress ulcer prophylaxis in comatose patients with brain stroke. The prospective study included 100 comatose patients with brain stroke with conscious level 5-8 by Glasgow Coma Scale (GCS) without gastric ulcer anamnesis. The average age was 63,2±13,1 years (male/female = 62/38). We concluded that the comatose patients with brain stroke who suspected to die during intensive care unit (ICU) stay have higher level of blood pressure and pulse rate during the first three days, compared to survived patients. The stress-response in comatose patients was evaluated analyzing plasma level of prolactin, cortisol in the morning and evening. The statistically significant difference was found in the morning prolactinemia between the group of survived and died patients (284,1±14,3 and 219,2±15,7 мIU/L respectively; р=0,04). The increased plasma level and affected circadian rhythm of cortisol were found in all patients. Hypercortisolemia was more excessive in patients, who died in ICU, than in survived patients. The level of cortisolemiae was in patients with lethal prognosis 1533,0±25,2 nmol/L in the morning and 1422,1±29,8 nmol/L in the evening. In survived patients the cortisolemia was 787,2±30,8 nmol/L in the morning and 709,9±34,7 nmol/L in the evening (intergroup р<0,000001). We found negative moderate correlation between GCS score and cortisolemiae in the morning: r = - 0,52, p < 0, 00001; and in the evening: r = - 0,46, p < 0, 00001. The maximal level of glycemia on the 1 day was 9,2±2,8 mmol/L, minimal - 5,8±1,9 mmol/L, and daily average - 7,5±2,3 mmol/L. During 5 days the glycemia decreased significantly up to: maximal - 6,8±1,6 mmol/L, minimal - 4,5±1,2 mmol/L, daily average - 5,7±1,4 mmol/L (р<0,00001). The glycemia was higher in patients with lethal prognosis, compared to survived ones. The intergroup difference in daily average glycemia was on the first day - 3,0 mmol/L (р=0,03), on the third day - 1,8 mmol/L (р=0,002), аnd on the fifth day - 1,7 mmol/L (р<0,00001). We analyzed the dynamics of intragastric рН related to Helicobacter pylori test in comatose patients. Intragastric pH was measured using the acidogastrograph. In all patients were provided stool test for detecting antigens of Helicobacter pylori. 11 patients had positive results of stool test for Helicobacter pillory, and 89 patients had negative results. The intergroup difference in maximal, minimal and daily average level of intragastric pH was statistically insignificant at all study stages (р?0,3). We analyzed dynamics of intragastric рН related to stress ulcer prophylaxis method in comatose patients. All patients gave enteral nutrition throw tube. The medicamentous stress ulcer prophylaxis were provided in 56 patients having daily average intragastric pH < 2,5 at the 1 day: group HB (n=18) giving Н-2-histamine blocker agent, group IPI (n=38) giving ion pump inhibitor. In 44 patients with daily average intragastric pH > 2,5 at the 1 day no medicaments were used for stress ulser prophylaxis. The daily average intragastric pH in group HB was on the 1 day 2,4±0,44, on the 3 day - 4,54±1,5, and on the 5 day - 3,85±0,77. This parameter in the group IPI was on the 1 day 1,66±0,45, on the 3 day - 5,9±1,43, and on the 5 day - 5,37±1,44; and in the group EN: on the 1 day 2,98±0,65, on the 3 day - 3,41±0,45, and on the 5 day - 3,45±0,5. We concluded that the early enteral nutrition keeps the optimal level of intragastric pH. The ion pump inhibitors provide more potent inhibition of acidity of gastric content comparing to the Н-2-histamine blocker agents. The intragastric рН-monitoring is useful in evaluating of stress ulcer prophylaxis effectiveness in comatose patients. The mortality among all patients was 43%, in the Helicobacter pylori positive group - 63,6% (7/11), and in the Helicobacter pylori negative group - 40,4% (36/89), in group HB and IPI - 50%, and in group EN - 34%. The patients died mainly due to brain swelling. There were no patients having the clinical manifestation of stress ulcer gastric bleeding. The clinically insignificant stress ulceration in gastroduodenal region was found in 9.7% of cadavers. There were no significant relation between the prophylaxis method and incidence of stress lesions: ?2 = 0.269; critical value at significance level p <0.05 = 5.991. The odds ratio for incidence of stress lesions in group HB comparing to group EN: OR=2.0; 95%CI=0.108-36.956; in group IPB comparing to group EN: OR=1.75; 95%CI=0.143-21.434; in groups HB+IPB comparing to group EN: OR=1.826; 95%CI= 0.173-19.315. The difference was less between groups HB and IPB: OR=1.143; 95%CI=0.088-14.777. All 4 patients having erosions were Helicobacter-negative, and in those not having erosions were 7/30 positive/negative results of test for Helicobacter pylori. The positive test for Helicobacter pylori has no predictive value in the incidence of stress gastroduodenal lesions: ?2 = 0.913, критерій ?2 adjusted Yeats = 0.065 (p>0.05), bilateral Fisher exact test = 1.0, the power connection from weak to average. The level of intragastric pH did not differ significantly between these two groups.
