非甾体消炎药上消化道不良反应的防治

Management of the upper gastrointestinal adverse effect of non-steroid anti-inflammatory drugs

非甾体消炎药(non-steroid anti-inflammatory drugs,NSAIDs)可不同程度地引起胃肠道不良反应,是临床引起消化性溃疡和上消化道出血的常见药物,特别是在一些高危人群。此外还可增加患者的心血管事件如心肌梗死和卒中的危险,这使NSAIDs的药物选择和不良反应防治成为重要的临床和经济问题。NSAIDs的使用应选择恰当和必须的患者,并尽可能选用最小的剂量和最短的时间,并尽量避免多种NSAIDs联用。长期用药应限于那些不能耐受其他类型的镇痛药、并且能经常随访的患者。对NSAIDs消化道不良反应发生高危人群的用药应参照指南并积极采取预防措施。

Non-steroid anti-inflammatory drugs （NSAIDs） is a group of commonly prescribed drugs with anti- inflammatory, analgesic, antipyretic properties. They all have an effect on inhibiting cyclooxygenase （COX） activity and blocking inflammatory prostaglandins synthesis. Based on their selectivity on COX isoenzymes, they were categorized into non-selective COX inhibitors, selective and highly selective COX-2 inhibitors. The clinical usage of NSAIDs may induce gastrointestinal adverse effect to varying degrees, and is one of the major causes of peptic ulcer and upper gastrointestinal bleeding in the patients, especially the highrisk population. In addition, some of the NSAIDs may increase the risk of cardiovascular events including acute myocardial infarction and stroke. The selection of NSAIDs and the prevention of their adverse effects have significant clinical and economic importance. NSAIDs should be administrated to appropriate and obligatory patients, with the minimum dosage and duration, and avoid being used in combination. Long-term administration should be limited to those patients that intolerant to other types of analgesia and compliant with frequent follow-up. For those patients with high risk of gastrointestinal adverse effects of NSAIDs, the selection of drugs should refer to current guideline for NSAIDs use and take preventing measures.