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Intens Care Med:危重病人预防应激性溃疡的疗效和安全性分析!

2017-12-15 xing.T MedSci原创

由此可见,该研究的结果提供了中等质量的证据表明PPIs是预防CIB最有效的药物,但它们可能增加肺炎的风险。利弊平衡使得SUP的常规使用受到了质疑。

应激性溃疡预防(SUP)常用于重症监护病房。然而,系统评价和常规荟萃分析的数据受到了不准确信息的限制,仅限于直接比较。近日,危重病医学领域权威杂志Intensive Care Medicine上发表了一篇荟萃分析文章,研究人员对评估危重病患者服用药物进行SUP的安全性和有效性的随机临床试验(RCTs)进行网络荟萃分析。

研究人员检索了MEDLINE、EMBASE和Cochrane图书馆对照试验登记中心数据库,检索时间至2017年4月,研究人员确定了评估危重患者服用质子泵抑制剂(PPIs)、组胺-2受体拮抗剂(H2RAs)和硫糖铝进行SUP的有效性和安全性的随机对照试验。没有日期或语言的限制。研究特征、方法、结果和偏倚风险的数据由两位评价者进行提取。

在96项可能符合条件的研究中,研究人员纳入了57项试验,共招募了7293例患者。结果显示PPI可能比H2Ras[比值比(OR)为0.38; 95%可信区间(CI)为0.20-0.73]、硫糖铝(OR为0.30;95%CI为0.13-0.69)和安慰剂(OR为0.24;95%CI为0.10-0.60)能更有效地预防临床上重要的消化道出血(CIB)(均为中等质量证据)。H2RA、硫糖铝和安慰剂之间没有令人信服的差异。与H2RAs(OR为1.27; 95%CI为0.96-1.68)、硫糖铝(OR为1.65;95%CI为1.20-2.27)和安慰剂(OR为1.52;95%CI为0.95-2.42)相比,PPI可能增加发生肺炎的风险(中等质量)。各种干预措施的死亡率可能相似(中等质量)。不同研究间出血的基线风险估计有着显著差异,只有一项研究报道了艰难梭菌感染。肺炎的定义差异很大,大多数关于硫糖铝的研究早于肺炎预防策略。

由此可见,该研究的结果提供了中等质量的证据表明PPIs是预防CIB最有效的药物,但它们可能增加肺炎的风险。利弊平衡使得SUP的常规使用受到了质疑。

原始出处:


Waleed Alhazzani, et al. Efficacy and safety of stress ulcer prophylaxis in critically ill patients: a network meta-analysis of randomized trials.Intensive Care Medicine.2017. http://icmjournal.esicm.org/journals/abstract.html?v=0&j=134&i=0&a=5005_10.1007_s00134-017-5005-8&doi=

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    2018-06-30 1771ae4158m

    学习一下很不错

    0

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beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49294, encryptionId=91554929461, topicName=应激性溃疡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee2d11842055, createdName=mfx803, createdTime=Sun Dec 17 08:22:00 CST 2017, time=2017-12-17, status=1, ipAttribution=)]
    2018-05-09 1771ae4158m

    学习一下很不错

    0

  5. 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  6. 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    2017-12-23 1209e435m98(暂无昵称)

    学习了.谢谢分享

    0

  7. 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    2017-12-21 1209e435m98(暂无昵称)

    学习了.谢谢分享!

    0

  8. 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createdTime=Sat Jun 30 06:56:18 CST 2018, time=2018-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2038796, encodeId=2b532038e9642, content=<a href='/topic/show?id=b45d1e274e8' target=_blank style='color:#2F92EE;'>#TENS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17274, encryptionId=b45d1e274e8, topicName=TENS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3b172500206, createdName=12498ebem19暂无昵称, createdTime=Mon Aug 13 11:22:00 CST 2018, time=2018-08-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313497, encodeId=452431349e5f, content=学习一下很不错, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Sat Dec 23 00:49:49 CST 2017, time=2017-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=271089, encodeId=d1aa2e1089d2, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Dec 21 06:58:10 CST 2017, time=2017-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=270979, encodeId=67c02e097905, content=好好好好学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM6DGOvNrRdcib3UmzMgpEQpl0ENSJScphsFtdgfibXX1g1IuEYGCjP23UqCd52TxTpSZibtPiclyusaHicnNXd78alaia19Qy1nAFo18/0, createdBy=50381491660, createdName=zwjnj2, createdTime=Wed Dec 20 19:49:23 CST 2017, time=2017-12-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1445190, encodeId=253c14451904a, content=<a href='/topic/show?id=61e74928629' target=_blank style='color:#2F92EE;'>#应激#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=56, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49286, encryptionId=61e74928629, topicName=应激)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=医者仁心, createdTime=Sun Dec 17 08:22:00 CST 2017, time=2017-12-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1527341, encodeId=434d152e34132, content=<a href='/topic/show?id=91554929461' target=_blank style='color:#2F92EE;'>#应激性溃疡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49294, encryptionId=91554929461, topicName=应激性溃疡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ee2d11842055, createdName=mfx803, createdTime=Sun Dec 17 08:22:00 CST 2017, time=2017-12-17, status=1, ipAttribution=)]
    2017-12-20 zwjnj2

    好好好好学习学习学习

    0

  9. 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Sat Dec 23 00:49:49 CST 2017, time=2017-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=271089, encodeId=d1aa2e1089d2, content=学习了.谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=94, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Thu Dec 21 06:58:10 CST 2017, time=2017-12-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=270979, encodeId=67c02e097905, content=好好好好学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=96, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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  10. 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