质子泵抑制剂和H_2受体阻滞剂预防术后应激性溃疡出血的系统评价和meta分析
详细信息 查看官网全文
摘要
目的:评价质子泵抑制剂和H_2受体阻滞剂预防术后应激性溃疡出血的疗效和安全性。方法:检索Cochrane Library,MEDLINE,EMbase,CNKI、CBM、VIP、Wan Fang Data、临床实验注册网站(clinicaltrial s.gov,ISRCTN Register,and WHO ICTRP),检索时间均为建库至2016年3月1日。收集PPI与H_2RA比较用于预防术后应激性溃疡出血的RCT。由两位研究者独立进行文献筛选、资料提取和方法学质量评价,采用Revman5.3统计软件进行meta分析,应用Grade评价证据质量。结果:共纳入17项RCT,Meta分析显示PPI应激性溃疡出血发生率低于H_2RA(RR 0.34,95%CI:0.24~0.48;P<0.00001)(中等强度证据),但隐性出血和显性出血发生率方面PPI和H_2RA无显著差异(均为极低质量证据),同时两者在死亡率(RR 0.39,95%CI:0.12~1.30,P=0.12)、不良反应发生率(RR 0.58,95%CI0.16~1.93;P=0.38)方面均无显著差异(极低质量证据)。结论:PPI预防应激性溃疡出血的疗效总体优于H_2RA,但PPI和H_2RA在死亡率、不良反应发生率、隐性出血发生率、显性出血发生率方面无显著差异。
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[J]Pol Arch Med Wewn 2012;122(3):107-114
[3]Krag M,PernA,Wetterslev J,et al.Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients.Intensive Care Med 2015;41(5):833-845
[4]Higgins JP,Altman DG,Gotzsche PC,et al.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ.2011;343:d5928.DOI:10.1136/bmj.d5928
[5]Guyatt GH,Oxman AD,Vist GE,et al.GRADE:an emerging consensus on rating quality of evidence and strength of recommendations.BMJ.2008;336(7650):924-926.
[6]李素玉,许朝卿,何英,等.泮托拉唑针剂预防应激性溃疡临床观察[J].亚太传统医药,2010,06(10):132-133
[7]刘国林.洛赛克预防口腔颌面外科术后应激性溃疡出血疗效评价[J].中国误诊学杂志,2011,11(21):5089-5089
[8]周纯智.奥美拉唑预防急腹症术后并发应激性溃疡的疗效观察[J].中国社区医师,2014,2(15):53-55.DOI:10.3969/j.issn.1007-614x.2014.15.32
[9]崔建军,王丽,蔺志清.泮托拉唑与西咪替丁治疗颅脑手术病人并发应激性溃疡的研究[J].河南诊断与治疗杂志,2002,16(03):194-194.
[10]Hata,M,Shiono,M,Sekino,H,et al.,Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery.Circulation J,2005.69(3):331-334.
[11]李小荣,谭辉,王志明.潘托拉唑预防和治疗腹部大手术后应激性溃疡[J].中国医师杂志,2003,5(05):620-621
[12]王伟丰,杨瑞生,李庆安,等.奥美拉唑对降低颅脑损伤术后应激性消化道出血发生率效果[J].中国伤残医学,2014,000(024):71-72.
[13]王玉宝.颅脑术后Cushing's溃疡的药物预防研究[J].河南外科学杂志,2003,9(01):13-14.
[14]王飞,吴玉勤,张孝忠等.奥美拉唑对颅脑手术并发应激性溃疡出血的预防和治疗[J].哈尔滨医药,2000,020(004):12-13
[15]王飞,梁凯,周可伟等.泮托拉唑预防和治疗颅脑手术并发应激性溃疡[J].华北煤炭医学院学报,2007,9(06):821-822
[16]管明,李晗宇,张冰等.泮托拉唑预防急性重症胆管炎术后消化系统并发症观察[J].中国药师,2013,16(08):1204-1205
[17]陈明建,丁春元,胡义平.奥美拉唑雷尼替丁预防颅脑损伤术后应激性胃出血比较[J].医药导报,2001,20(07):435-436
[18]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
[19]Skala,I,Mareckova,O,Vitko,S,et al.Prophylaxis of acute gastroduodenal bleeding after renal transplantation.Transplant International,1997,10(5):375-378
[20]Hsu,T C,Su,C F,Leu,S C,et al.,Omeprazole is more effective than a histamine H2-receptor blocker for maintaining a persistent elevation of gastric pH after colon resection for cancer.The American Journal of Surgery,2004.187(1):20-23
[21]Memis D,Turan A,Karamanlioglu B,et al..The effect of intravenous pantaprazole and ranitidine for improving preoperative gastric fluid properties in adults undergoing elective surgery.Anesth Analg.2003;97:1360-3
[22]Maasoumi G,Farahbakhsh F,Shahzamani M,et al.A.Comparing the Effects of Pantoprazole and Ranitidine in the Prevention of Post-Operative Gastrointestinal Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery.J Isfahan Med Sch 2016;34(376):270-276
[23]Hurt RT,Frazier TH,McClave SA,et al:Stress prophylaxis in intensive are unit patients and the role of enteral nutrition.JPEN J Parenterteral Nutr 2012;36(6):721-731
[2]Alhazzani W,Alshahrani M,Moayyedi P,et al.Stress ulcer prophylaxis in critically ill patients:Review of the evidence[J]Pol Arch Med Wewn 2012;122(3):107-114
[3]Krag M,PernA,Wetterslev J,et al.Prevalence and outcome of gastrointestinal bleeding and use of acid suppressants in acutely ill adult intensive care patients.Intensive Care Med 2015;41(5):833-845
[4]Higgins JP,Altman DG,Gotzsche PC,et al.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.BMJ.2011;343:d5928.DOI:10.1136/bmj.d5928
[5]Guyatt GH,Oxman AD,Vist GE,et al.GRADE:an emerging consensus on rating quality of evidence and strength of recommendations.BMJ.2008;336(7650):924-926.
[6]李素玉,许朝卿,何英,等.泮托拉唑针剂预防应激性溃疡临床观察[J].亚太传统医药,2010,06(10):132-133
[7]刘国林.洛赛克预防口腔颌面外科术后应激性溃疡出血疗效评价[J].中国误诊学杂志,2011,11(21):5089-5089
[8]周纯智.奥美拉唑预防急腹症术后并发应激性溃疡的疗效观察[J].中国社区医师,2014,2(15):53-55.DOI:10.3969/j.issn.1007-614x.2014.15.32
[9]崔建军,王丽,蔺志清.泮托拉唑与西咪替丁治疗颅脑手术病人并发应激性溃疡的研究[J].河南诊断与治疗杂志,2002,16(03):194-194.
[10]Hata,M,Shiono,M,Sekino,H,et al.,Prospective randomized trial for optimal prophylactic treatment of the upper gastrointestinal complications after open heart surgery.Circulation J,2005.69(3):331-334.
[11]李小荣,谭辉,王志明.潘托拉唑预防和治疗腹部大手术后应激性溃疡[J].中国医师杂志,2003,5(05):620-621
[12]王伟丰,杨瑞生,李庆安,等.奥美拉唑对降低颅脑损伤术后应激性消化道出血发生率效果[J].中国伤残医学,2014,000(024):71-72.
[13]王玉宝.颅脑术后Cushing's溃疡的药物预防研究[J].河南外科学杂志,2003,9(01):13-14.
[14]王飞,吴玉勤,张孝忠等.奥美拉唑对颅脑手术并发应激性溃疡出血的预防和治疗[J].哈尔滨医药,2000,020(004):12-13
[15]王飞,梁凯,周可伟等.泮托拉唑预防和治疗颅脑手术并发应激性溃疡[J].华北煤炭医学院学报,2007,9(06):821-822
[16]管明,李晗宇,张冰等.泮托拉唑预防急性重症胆管炎术后消化系统并发症观察[J].中国药师,2013,16(08):1204-1205
[17]陈明建,丁春元,胡义平.奥美拉唑雷尼替丁预防颅脑损伤术后应激性胃出血比较[J].医药导报,2001,20(07):435-436
[18]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
[19]Skala,I,Mareckova,O,Vitko,S,et al.Prophylaxis of acute gastroduodenal bleeding after renal transplantation.Transplant International,1997,10(5):375-378
[20]Hsu,T C,Su,C F,Leu,S C,et al.,Omeprazole is more effective than a histamine H2-receptor blocker for maintaining a persistent elevation of gastric pH after colon resection for cancer.The American Journal of Surgery,2004.187(1):20-23
[21]Memis D,Turan A,Karamanlioglu B,et al..The effect of intravenous pantaprazole and ranitidine for improving preoperative gastric fluid properties in adults undergoing elective surgery.Anesth Analg.2003;97:1360-3
[22]Maasoumi G,Farahbakhsh F,Shahzamani M,et al.A.Comparing the Effects of Pantoprazole and Ranitidine in the Prevention of Post-Operative Gastrointestinal Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery.J Isfahan Med Sch 2016;34(376):270-276
[23]Hurt RT,Frazier TH,McClave SA,et al:Stress prophylaxis in intensive are unit patients and the role of enteral nutrition.JPEN J Parenterteral Nutr 2012;36(6):721-731