奥美拉唑预防卒中后应激性溃疡出血疗效的Meta分析
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摘要
目的系统评价奥美拉唑预防卒中后患者应激性溃疡出血(stress ulceration and bleeding,SUB)的疗效,及其与H_2受体阻滞剂(histamine-2 receptor antagonists,H_2RA)疗效的对比。方法计算机检索Cochrane、Pub Med、Embase、CNKI、Wan Fang和VIP。纳入奥美拉唑预防卒中后SUB的随机对照试验,对纳入的研究采用Rev Man 5.2软件进行Meta分析。结果共纳入17个随机对照试验(1739例患者)。Meta分析结果显示:预防性使用奥美拉唑能降低卒中后SUB的发生率[比值比(odds ratio,OR)0.1,95%可信区间(confidence interval,CI)0.06~0.14,P<0.00001];奥美拉唑降低卒中后患者SUB的发生率效果优于H_2RA(OR 0.24,95%CI 0.15~0.38,P<0.00001);奥美拉唑可降低卒中后患者的病死率(OR 0.17,95%CI 0.09~0.33,P<0.00001)。结论现有证据表明,预防性使用奥美拉唑,能降低卒中后患者SUB的发生率与病死率,且其效果优于H_2RA。
Objective To evaluate the preventive effects of omeprazole against stress ulcer bleeding(USB)for post-stroke patients,and compare their effectiveness between Histamine-2 receptor antagonists(H_2RA).Methods Cochrane,Pud Med,Embase,CNKI,Wang Fang and VIP were searched systematically.Case-control studies of omeprazole protects against SUB for post stroke patients were included,and the articles were performed Meta analysis by Rev Man 5.2 software.Results A total of 17 case-control studies(1739 cases)were included.The results of meta-analysis were as followed:Prophylactic use of omeprazole could decrease the incidence of SUB for post-stoke patients[odds ratio(OR)0.01,95%confidence interval(CI)0.06-0.14,P<0.00001];and the treatment effectives of USB with omeprazole was better than H_2RA(OR 0.24,95%CI 0.15-0.38,P<0.00001).The use of omeprazole could decrease the mortality of post-stroke patients(OR 0.17,95%CI 0.09-0.33,P<0.0001).Conclusion Evidence indicates that prophylactic use of omeprazole can decrease the incidence of SUB and mortality among post-stoke patients,and the effectiveness is better than H_2RA.
Objective To evaluate the preventive effects of omeprazole against stress ulcer bleeding(USB)for post-stroke patients,and compare their effectiveness between Histamine-2 receptor antagonists(H_2RA).Methods Cochrane,Pud Med,Embase,CNKI,Wang Fang and VIP were searched systematically.Case-control studies of omeprazole protects against SUB for post stroke patients were included,and the articles were performed Meta analysis by Rev Man 5.2 software.Results A total of 17 case-control studies(1739 cases)were included.The results of meta-analysis were as followed:Prophylactic use of omeprazole could decrease the incidence of SUB for post-stoke patients[odds ratio(OR)0.01,95%confidence interval(CI)0.06-0.14,P<0.00001];and the treatment effectives of USB with omeprazole was better than H_2RA(OR 0.24,95%CI 0.15-0.38,P<0.00001).The use of omeprazole could decrease the mortality of post-stroke patients(OR 0.17,95%CI 0.09-0.33,P<0.0001).Conclusion Evidence indicates that prophylactic use of omeprazole can decrease the incidence of SUB and mortality among post-stoke patients,and the effectiveness is better than H_2RA.
引文
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[14]余建国.奥美拉唑预防脑出血并发应激性溃疡出血[J].中国医院药学杂志,2005,25(4):352-353.
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[17]闫春玲.洛赛克针剂预防脑出血并发应激性溃疡出血临床观察[J].河北职工医学院学报,2007,19(5):438-439.
[18]冯瑞晶.早期应用奥美拉唑预防脑出血并发应急性溃疡出血的疗效观察[J].中国实用医药,2010,5(17):161-162.
[19]王海涛,李志伟,殷春明,等.早期应用抑酸药预防急性脑血管病后应激性溃疡出血的临床观察[J].医学信息,2011,24(9):4369-4370.
[20]郭艳青,王前进.奥美拉唑治疗急性重型脑出血并发应激性溃疡的临床研究[J].中国医药指南,2013,11(9):217-218.
[21]李秀针.奥美拉唑治疗脑出血并发应激性溃疡的临床观察[J].中国实用神经疾病杂志,2011,14(9):74-75.
[22]王家松,郭建选,胡文立.洛赛克与甲氰咪胍预防脑出血并发应激性溃疡出血的疗效比较[J].遵义医学院学报,2005,28(4):362-363.
[23]张兆芳.洛赛克预防急性脑出血并发应激性溃疡出血的临床观察[J].现代中西医结合杂志,2007,16(15):2061-2062.
[24]黄文胜,耿学敬.洛赛克治疗急性脑血管病并发应激性溃疡出血临床观察[J].临床荟萃,1997,12(5):234.
[25]朱旭星,王光助,应光荣,等.抑酸药预防高血压脑出血并发胃肠出血116例[J].世界华人消化杂志,2002,10(8):987.
[26]隗茂芸,刘芳.急性脑卒中后抑酸药预防性应用情况调查和循证医学评价[J].中国临床药学杂志,2011,20(5):286-290.
[27]中华医学杂志编辑委员会.应激性溃疡防治建议[J].中华医学杂志,2002,82(14):1000-1001.
[2]WANG C,HAN J,XIAO L,et al.Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding:a systematic review and meta-analysis[J].Hepatol Int,2015,9(1):120-129
[3]陈志军,叶兰芬,彭宙,等.探讨重型颅脑损伤后应激性溃疡的发病机制及防治措施[J].中外医疗,2013,32(23):20-22.
[4]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257.
[5]石剑锋.应激性溃疡防治的研究进展[J].现代预防医学,2013,40(1):166-167.
[6]各类脑血管疾病诊断要点[J].中华神经科杂志,1996,29(6):379-380.
[7]WOOD P H.Appreciating the consequences of disease:the international classification of impairments,disabilities,and handicaps[J].WHO Chron,1980,34(10):376-380.
[8]刘建平,夏芸.中文期刊发表的中医药系统综述或Meta-分析文章的质量评价[J].中国中西医结合杂志,2007,27(4):306-311.
[9]满晓辉,王琳.奥美拉唑用于预防脑出血并上消化道出血的临床观察[J].中国医药指南,2015,13(23):89-90.
[10]胡义平,陈明建.奥美拉唑与雷尼替丁用于预防高血压并发脑出血术后应激性溃疡出血的临床研究[J].新医学,2001,32(10):598-599.
[11]陈素芳.奥美拉唑预防高血压脑卒中溃疡出血60例观察[J].基层医学论坛,2013,17(14):1789-1790.
[12]王英俊.奥美拉唑预防急性脑出血并发应激性溃疡出血的临床观察[J].现在中西医结合杂志,2008,17(4):578.
[13]黄永峰.奥美拉唑预防急性脑出血并发应激性消化道出血的效果观察[J].医学理论与实践,2004,17(10):1166-1167.
[14]余建国.奥美拉唑预防脑出血并发应激性溃疡出血[J].中国医院药学杂志,2005,25(4):352-353.
[15]付文亭,邵长娟,李清.奥美拉唑预防自发性脑出血并发上消化道出血的临床观察[J].中国社区医师,2009,19(220):19.
[16]陈卫东,李杰,黄万景.洛赛克针剂预防脑出血并发应激性溃疡出血临床观察[J].右江民族医学院学报,2005,27(4):486-487.
[17]闫春玲.洛赛克针剂预防脑出血并发应激性溃疡出血临床观察[J].河北职工医学院学报,2007,19(5):438-439.
[18]冯瑞晶.早期应用奥美拉唑预防脑出血并发应急性溃疡出血的疗效观察[J].中国实用医药,2010,5(17):161-162.
[19]王海涛,李志伟,殷春明,等.早期应用抑酸药预防急性脑血管病后应激性溃疡出血的临床观察[J].医学信息,2011,24(9):4369-4370.
[20]郭艳青,王前进.奥美拉唑治疗急性重型脑出血并发应激性溃疡的临床研究[J].中国医药指南,2013,11(9):217-218.
[21]李秀针.奥美拉唑治疗脑出血并发应激性溃疡的临床观察[J].中国实用神经疾病杂志,2011,14(9):74-75.
[22]王家松,郭建选,胡文立.洛赛克与甲氰咪胍预防脑出血并发应激性溃疡出血的疗效比较[J].遵义医学院学报,2005,28(4):362-363.
[23]张兆芳.洛赛克预防急性脑出血并发应激性溃疡出血的临床观察[J].现代中西医结合杂志,2007,16(15):2061-2062.
[24]黄文胜,耿学敬.洛赛克治疗急性脑血管病并发应激性溃疡出血临床观察[J].临床荟萃,1997,12(5):234.
[25]朱旭星,王光助,应光荣,等.抑酸药预防高血压脑出血并发胃肠出血116例[J].世界华人消化杂志,2002,10(8):987.
[26]隗茂芸,刘芳.急性脑卒中后抑酸药预防性应用情况调查和循证医学评价[J].中国临床药学杂志,2011,20(5):286-290.
[27]中华医学杂志编辑委员会.应激性溃疡防治建议[J].中华医学杂志,2002,82(14):1000-1001.