不同质子泵抑制剂对心脏大血管手术患者围术期应激性溃疡预防的疗效观察及药物经济学评价

Therapeutic efficacy and pharmacoeconomic evaluation of different proton pump inhibitor regimens for prevention of perioperative stress ulcer in patients undergoing macrovascular cardiac surgery

目的评价不同质子泵抑制剂对心脏大血管手术患者术后应激性溃疡的预防效果及经济性。方法收集2015年冠状动脉心肌梗死搭桥手术及心脏瓣膜置换手术患者600例,分为奥美拉唑、埃索美拉唑、兰索拉唑组3组,疗程分为1周及2周。观察九组给药方案在3个月内发生消化性溃疡或出血事件情况、死亡情况并应用药物经济学的成本-效果分析法对治疗方案进行经济学评价。结果冠状动脉心肌梗死搭桥患者消化道溃疡发生率高于瓣膜置换患者(P<0.05);不同质子泵抑制剂间消化道溃疡的发生率差异无统计学意义;口服给药低于静脉给药,其中奥美拉唑口服组成本最低,为40.16元。结论质子泵抑制剂能够有效预防心脏大血管手术患者术后应激性溃疡的发生,其中口服给药能够收获与静脉给药同样的效果,并具有较高的经济性。

Objective To evaluate the therapeuticefficacy and cost-effectiveness of different proton pump inhibitors for prevention of postoperative stress ulcer in patients undergoing macrovascular cardiac surgery. Methods Six hund redpatients undergoing coronary artery bypass or cardiac valve replacement surgery in 2015 were retrospec-tively enrolled in the study and assigned to omeprazole, esomeprazole, and lansoprazole groups. The course of treat-ment was one or two weeks. Nine regimens of these medications were compared for 3-month incidence of peptic ulcer,hemorrhagic events and mortality. Pharmacoeconomics of these regimens was evaluated basedon the cost-effectiveness.Results The incidence rate of pepticulcer in patients undergoing coronary artery bypass grafting was higher com-pared with those undergoing heart valve replacement(P<0.05). There was no significant difference in the incidence of peptic ulcer between different proton pump inhibitor regimens. The medical cost was lower with oral administration than with intravenous administration, and was lowest with oral omeprazol(40.16 yuan RMB). Conclusion: Proton pump inhibitorsmaye ffectively prevent postoperative stress ulcer in patients undergoing macrovascular cardiac surgery. Oral administration of the seagents may offer comparable efficacy as with intravenous administration, meanwhile with better cost-effectiveness.