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Chest:危重症患者预防应激性溃疡 PPI遭到嫌弃?

2018-09-30 吴星 环球医学网

质子泵抑制剂(PPIs)和组胺2型受体阻滞剂(H2Bs)是重症监护实践中应激性溃疡的主要预防药物。1999年美国卫生系统药师协会指南推荐H2Bs,但随后的荟萃分析支持PPIs,两者不一致。

质子泵抑制剂(PPIs)和组胺2型受体阻滞剂(H2Bs)是重症监护实践中应激性溃疡的主要预防药物。1999年美国卫生系统药师协会指南推荐H2Bs,但随后的荟萃分析支持PPIs,两者不一致。

这些荟萃分析中包含研究的方法学缺陷,引发了在重症监护实践中,关于哪个替代疗法预防出血更优越的担忧。此外,由于接受PPI组的敏锐度较高,以及根据ICU聚集的预防药物的类型,H2Bs保护作用的估计可能会被夸大。

而且,最近的成本效果分析假设PPIs具有更好的预防出血的能力,结果发现H2Bs预防比PPIs预防更具成本效果。

2018年9月,发表在《Chest》的一项基于人群的研究,旨在确定危重症成年患者中,与H2Bs相比,预防性使用PPIs是否与临床肠道大出血(CIGIB)风险的降低相关。

该项回顾性队列研究纳入了2008年1月1日~2012年6月30日的成年危重症患者,这些患者具有至少1个应激性溃疡风险因素,并接受了≥3天的PPI或H2B。Cox成比例风险回归倾向得分匹配和工具变量分析,用于控制选择偏倚和未测量因素的混杂。急性生理和慢性健康评估评分IV版得分,用于调整敏锐度的差异。主要结局和暴露为CIGIB。

70093名处于风险的患者中,49576人(70.7%)接受预防治疗至少3天,424人(0.6%)满足 CIGIB的定义。

PPI使用者比H2B使用者CIGIB风险高两倍(调整HR,1.82;HR,2.37)。敏感性分析未能发现PPIs在预防CIGIB上优于H2Bs。

作者认为,在该人群中,与PPIs相比,H2Bs与显着性低的CIGIB风险强烈一致相关。

CIGIB是接受应激性溃疡预防药物的重症患者中罕见的结果。与临床研究的结果不同,临床实践中,PPIs的CIGIB风险高于H2Bs。

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    2019-06-04 Smile2680
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    2018-10-06 121832a9m88暂无昵称

    学习了

    0

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