应激性溃疡预防用药指征的相关文献分析

Literature review on prophylactic indication for stress ulcer

目的考察应激性溃疡的预防用药指征,为应激性溃疡预防用药的合理使用提供参考依据。方法系统检索Medline、Embase、Cochrane、CNKI和万方数据库,根据纳入、排除标准筛选文献,提取相关资料,并进行归纳总结。结果目前关于应激性溃疡预防的研究主要集中在重症患者,相关指南和共识的质量不高。应激性溃疡预防用药适用于具有出血风险比较高的患者,主要涉及患者的疾病状态(胃肠道溃疡或出血史、机械通气、凝血功能障碍、脏器功能不全等)、用药情况(抗血栓药物、非甾体抗炎药、大剂量激素等)和手术操作情况等。结论应激性溃疡预防用药应针对高危人群,目前临床证据有限,需要进一步明确应激性溃疡预防用药指征,并按照标准化流程制定针对特定人群的指南或共识,以增加临床实用性。

Objective To summarize the prophylactic indication of stress ulcer,and provide evidence for proper use of agents in this field. Methods Electronic databases including Medline,Embase,Cochrane library,CNKI and Wangfang were systematically reviewed. The prophylactic indication of the stress ulcer were screened,extracted and summarized. Results Studies about the stress ulcer were mainly for critical ill patients,and the guidelines/consensus were low in quality. Pharmaceutical prophylaxis should be applied to patients with high risk of stress ulcer,those with specific diseases( previous peptic ulcer or bleeding history,mechanical ventilation,coagulopathy,dysfunction of organs,etc.),agents( non-steroidal anti-inflammatory drugs,corticosteroids),and surgical operations. Conclusion Pharmaceutical prophylaxis should be used only in patients with high risk. More studies are needed to confirm the indications for current clinical evidence is limited. Guidelines/consensus for specific patients should be conducted according to the standardized procedure to promote the rational use of agents.