药物预防应激性溃疡的系统综述
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摘要
目的:综述应激性溃疡出血(stress ulcer bleeding,SUB)发生率、危险因素和预防方案的有效性、安全性和经济性。方法:检索MEDLINE,Embase,Cochrane(Central),CNKI、CBM,VIP,Wan Fang,提取总结相关数据。结果:肠内营养是SUB的保护因素。3项RCT研究结果均显示,在预防临床大出血方面PPI并非优于H_2RA。4项meta分析均认为PPI与肺炎发生有关(OR:1.04~1.92),5项meta分析均认为PPI能增加肠道感染的风险,尤其是难辨梭菌感染(OR:1.69~3.33)。2项回顾性研究显示,服用PPI的患者慢性肾病发生风险高且与用药频次有关。3项对比PPI和H_2RA预防SUB的成本效益的经济学研究,结果显示在预防SUB时,肠内奥美拉唑最优;在预防SUB和并发症时,PPI最优;PPI组和H_2RA组死亡率相同时,H_2RA预防SUB成本低于PPI结论:危重患者使用抑酸药预防SUB前应先进行风险因素评估。鉴于临床大出血发生率低,临床医生应考量预防SUB用药的必要性、安全性及经济性。
引文
[1]林金锋.应激性溃疡预防性治疗的研究进展[J].中国急救医学,2014,34(5):468-472
[2]Alhazzani W,Alshahrani M,Moayyedi P,et al:Stress ulcer prophylaxis in critically ill patients:Review of the evidence.Pol Arch Med Wewn 2012;122:107-114
[3]Krag M,Pemer A,Wetterslev J,et al;SUP-ICU co-authors:Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients.Intensive Care Med 2015;41:833-845
[4]Krag M,Pemer A,Wetterslev J,et al;SUP-ICU Collaborators:Stress ulcer prophylaxis in the intensive care unit:An international survey of97 units in 11 countries.ActaAnaesthesiolScand 2015;59:576-585
[5]Barletta JF,El-Ibiary SY,Davis LE,et al:Proton pump inhibitors andhe risk for hospital-acquired Clostridium diffiile infection.Mayo Clinroc 2013;88(10):1085-1090
[6]Barletta JF,Sclar DA:Proton pump inhibitors increase the risk forospital-acquired Clostridium diffiile infection in critically ill patients.rit Care 2014;18:714.
[7]Hurt RT,Frazier TH,McClave SA,et al:Stress prophylaxis in intensive care unit patients and the role of enteral nutrition.JPEN J Parenter Enteral Nutr 2012;36:721-731
[8]Marik PE:Stress ulcer prophylaxis in the new millennium.ICU Director 2010;1:12-16
[9]Conrad SA,Gabrielli A,Margolis B,et al:Randomized,double blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients.Crit Care Med 2005;33:760-765
[10]Kantorova I,Svoboda P,Scheer P,et al:Stress ulcer prophylaxis in critically ill patients:A randomized controlled trial.Hepatogastroenterology 2004;51:757-761
[11]Levy MJ,Seelig CB,Robinson NJ,et al:Comparison of omeprazole and ranitidine for stress ulcer prophylaxis.Dig Dis Sci 1997;42:1255-1259
[12]Solouki M,Marashian S,ICouchak M:Comparison between the preventive effects of ranitidine and omeprazole on upper gastrointestinal bleeding among ICU patients.Tanaffos 2009;8:37-42
[13]Krag M,Pemer A,Wetterslev J,et al:Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients.A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.Intensive Care Med 2014;40:11—22
[14]MacLaren R,Reynolds PM,Allen RR:Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit.JAMA Intern Med 2014;174:564-574
[15]Alhazzani W,Alenezi F,Jaeschke RZ,et al:Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients:A systematic review and meta-analysis.Crit Care Med 2013;41:693-705
[16].Barkun AN,Bardou M,Pham CQ,et al:Proton pump inhibitors vs.histamine 2 receptor antagonists for stress-related mucosal bleeding prophylaxis in critically ill patients:A meta-analysis.Am J Gastroenterol 2012;107:507-520;quiz 521
[17]Lin PC,Chang CH,Hsu PI,et al:The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients:A meta-analysis.Crit Care Med 2010;38:1197-1205
[18]Pongprasobchai S,Kridkratoke S,Nopmaneejumruslers C:Proton pump inhibitors for the prevention of stress-related mucosal disease in critically ill patients:A meta-analysis.J Med Assoc Thai 2009;92:632-637
[19]Zedtwitz-Liebenstein K,Wenisch C,Patruta S,et al:Omeprazole treatment diminishes intra-and extracellular neutrophil reactive oxygen production and bactericidal activity.Crit Care Med 2002;30:1118-1122
[20]Bashar FR,Manuchehrian N,Mahmoudabadi M,et al:Effects of ranitidine and pantoprazole on ventilator-associated pneumonia:A randomized double-blind clinical trial.Tanaffos 2013;12:16-21
[21]Bateman BT,Bykov K,Choudhry NK,et al:Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients:Cohort study.BMJ 2013;347:f5416
[22]Herzig SJ,HcHveU MD,Ngo LH,et al:Add^uppiessive medicatxn use and te
[23]Kwok CS,Yeong JK,Loke YK.Meta-analysis:risk of fractures with acid-suppressing medication.Bone.2011;48:768776.
[24]Shukla S,Shukla A,Guha S,et al.Use of proton pump inhibitors and risk of Clostridium difficile-associated diarrhea:a meta-analysis.Gastroenterology.2010;138:S-209
[25]Janarthanan S,Ditah I,Adler DG,et al.Clostridium difficile-associated diarrhea and proton pump inhibitor therapy:a metaanalysis.Am J Gastroenterol.2012;107:1001-1010
[26]Deshpande A,Pant C,Pasupuleti V,et al.Association between proton pump inhibitor therapy and Clostridium difficile infection in a meta-analysis.Clin Gastroenterol Hepatol.2012;10:225-233.
[27]Leonard J,Marshall JK,Moayyedi P.Systematic review of the risk of enteric infection in patients taking acid suppression.Am J Gastroenterol.2007;102:2047-2056.
[28]MacLaren R,Kassel LE,Kiser TH,et al:Proton pump inhibitors and histamine-2 receptor antagonists in the intensive care setting:Focus on therapeutic and adverse events.Expert Opin Drug Saf 2015;14:269-280
[29]Udeh BL,Udeh C,Hata JS:Cost-effectiveness of stress ulcer prophylaxis:Role of proton pump inhibitors.Am J Pharm Benefits 2010;2:304-312
[30]Barkun AN,Adam V,Martel M,et al:Cost-effectiveness analysis:Stress ulcer bleeding prophylaxis with proton pump inhibitors,H2receptor antagonists.Value Health 2013;16:14-22
[31]MacLaren R,Campbell J:Cost-effectiveness of histamine receptor-2 antagonist versus proton pump inhibitor for stress ulcer prophylaxis in critically ill patients.Crit Care Med 2014;42:809-815
[2]Alhazzani W,Alshahrani M,Moayyedi P,et al:Stress ulcer prophylaxis in critically ill patients:Review of the evidence.Pol Arch Med Wewn 2012;122:107-114
[3]Krag M,Pemer A,Wetterslev J,et al;SUP-ICU co-authors:Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients.Intensive Care Med 2015;41:833-845
[4]Krag M,Pemer A,Wetterslev J,et al;SUP-ICU Collaborators:Stress ulcer prophylaxis in the intensive care unit:An international survey of97 units in 11 countries.ActaAnaesthesiolScand 2015;59:576-585
[5]Barletta JF,El-Ibiary SY,Davis LE,et al:Proton pump inhibitors andhe risk for hospital-acquired Clostridium diffiile infection.Mayo Clinroc 2013;88(10):1085-1090
[6]Barletta JF,Sclar DA:Proton pump inhibitors increase the risk forospital-acquired Clostridium diffiile infection in critically ill patients.rit Care 2014;18:714.
[7]Hurt RT,Frazier TH,McClave SA,et al:Stress prophylaxis in intensive care unit patients and the role of enteral nutrition.JPEN J Parenter Enteral Nutr 2012;36:721-731
[8]Marik PE:Stress ulcer prophylaxis in the new millennium.ICU Director 2010;1:12-16
[9]Conrad SA,Gabrielli A,Margolis B,et al:Randomized,double blind comparison of immediate-release omeprazole oral suspension versus intravenous cimetidine for the prevention of upper gastrointestinal bleeding in critically ill patients.Crit Care Med 2005;33:760-765
[10]Kantorova I,Svoboda P,Scheer P,et al:Stress ulcer prophylaxis in critically ill patients:A randomized controlled trial.Hepatogastroenterology 2004;51:757-761
[11]Levy MJ,Seelig CB,Robinson NJ,et al:Comparison of omeprazole and ranitidine for stress ulcer prophylaxis.Dig Dis Sci 1997;42:1255-1259
[12]Solouki M,Marashian S,ICouchak M:Comparison between the preventive effects of ranitidine and omeprazole on upper gastrointestinal bleeding among ICU patients.Tanaffos 2009;8:37-42
[13]Krag M,Pemer A,Wetterslev J,et al:Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients.A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis.Intensive Care Med 2014;40:11—22
[14]MacLaren R,Reynolds PM,Allen RR:Histamine-2 receptor antagonists vs proton pump inhibitors on gastrointestinal tract hemorrhage and infectious complications in the intensive care unit.JAMA Intern Med 2014;174:564-574
[15]Alhazzani W,Alenezi F,Jaeschke RZ,et al:Proton pump inhibitors versus histamine 2 receptor antagonists for stress ulcer prophylaxis in critically ill patients:A systematic review and meta-analysis.Crit Care Med 2013;41:693-705
[16].Barkun AN,Bardou M,Pham CQ,et al:Proton pump inhibitors vs.histamine 2 receptor antagonists for stress-related mucosal bleeding prophylaxis in critically ill patients:A meta-analysis.Am J Gastroenterol 2012;107:507-520;quiz 521
[17]Lin PC,Chang CH,Hsu PI,et al:The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care patients:A meta-analysis.Crit Care Med 2010;38:1197-1205
[18]Pongprasobchai S,Kridkratoke S,Nopmaneejumruslers C:Proton pump inhibitors for the prevention of stress-related mucosal disease in critically ill patients:A meta-analysis.J Med Assoc Thai 2009;92:632-637
[19]Zedtwitz-Liebenstein K,Wenisch C,Patruta S,et al:Omeprazole treatment diminishes intra-and extracellular neutrophil reactive oxygen production and bactericidal activity.Crit Care Med 2002;30:1118-1122
[20]Bashar FR,Manuchehrian N,Mahmoudabadi M,et al:Effects of ranitidine and pantoprazole on ventilator-associated pneumonia:A randomized double-blind clinical trial.Tanaffos 2013;12:16-21
[21]Bateman BT,Bykov K,Choudhry NK,et al:Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients:Cohort study.BMJ 2013;347:f5416
[22]Herzig SJ,HcHveU MD,Ngo LH,et al:Add^uppiessive medicatxn use and te
[23]Kwok CS,Yeong JK,Loke YK.Meta-analysis:risk of fractures with acid-suppressing medication.Bone.2011;48:768776.
[24]Shukla S,Shukla A,Guha S,et al.Use of proton pump inhibitors and risk of Clostridium difficile-associated diarrhea:a meta-analysis.Gastroenterology.2010;138:S-209
[25]Janarthanan S,Ditah I,Adler DG,et al.Clostridium difficile-associated diarrhea and proton pump inhibitor therapy:a metaanalysis.Am J Gastroenterol.2012;107:1001-1010
[26]Deshpande A,Pant C,Pasupuleti V,et al.Association between proton pump inhibitor therapy and Clostridium difficile infection in a meta-analysis.Clin Gastroenterol Hepatol.2012;10:225-233.
[27]Leonard J,Marshall JK,Moayyedi P.Systematic review of the risk of enteric infection in patients taking acid suppression.Am J Gastroenterol.2007;102:2047-2056.
[28]MacLaren R,Kassel LE,Kiser TH,et al:Proton pump inhibitors and histamine-2 receptor antagonists in the intensive care setting:Focus on therapeutic and adverse events.Expert Opin Drug Saf 2015;14:269-280
[29]Udeh BL,Udeh C,Hata JS:Cost-effectiveness of stress ulcer prophylaxis:Role of proton pump inhibitors.Am J Pharm Benefits 2010;2:304-312
[30]Barkun AN,Adam V,Martel M,et al:Cost-effectiveness analysis:Stress ulcer bleeding prophylaxis with proton pump inhibitors,H2receptor antagonists.Value Health 2013;16:14-22
[31]MacLaren R,Campbell J:Cost-effectiveness of histamine receptor-2 antagonist versus proton pump inhibitor for stress ulcer prophylaxis in critically ill patients.Crit Care Med 2014;42:809-815