肝硬化患者质子泵抑制剂用药情况与并发症的调查研究

Investigation on the use of proton pump inhibitors and complications in patients with liver cirrhosis

目的评估肝硬化患者质子泵抑制剂(PPI)的用药情况及与并发症之间的可能联系,为临床合理用药提供参考。方法基于问卷调查的形式调查临床医生对肝硬化患者PPI的用药模式,并对诊断为肝硬化的患者PPI用药及并发症发生情况进行统计分析。结果共182名医生参与本项调查,49.45%的医生认为PPI治疗与肝硬化患者的相关并发症有关,医生给肝硬化患者持续性使用PPI的主要原因中:腹部不适占52.75%、已经治愈的溃疡的长期预防占15.38%、预防食管胃静脉曲张破裂出血或再出血占27.47%。并236名肝硬化患者纳入回顾性研究,其中206人接受了PPI的治疗,51.94%无PPI适应症,2人发生自发性腹膜炎。结论临床医生对PPI在肝硬化患者中的应用的风险收益率不甚清楚,PPI可能增加相关并发症风险,迫切需要进一步的前瞻性数据,以增加有关肝硬化患者进行PPI治疗的适应症和疗程的证据。

Objective To evaluate the proton pump inhibitor(PPI)medication in patients with liver cirrhosis and the possible relationship between it and the occurrence of complications,and to provide a reference for clinical rational drug use.Methods Based on the questionnaire survey,the clinician's PPI medication pattern for patients with liver cirrhosis was investigated,and the PPI medication and complications of patients diagnosed with cirrhosis were statistically analyzed.Results A total of 182 doctors participated in this survey.49.45%of doctors believed that PPI treatment was related to complications related to patients with liver cirrhosis.The main reasons why doctors continued to use PPI for patients with liver cirrhosis were:abdominal discomfort accounted for 52.75%,cured Long-term prevention of ulcers accounted for 15.38%,and prevention of bleeding or rebleeding of esophageal and gastric varices accounted for 27.47%.A total of 236 patients with liver cirrhosis were included in the retrospective study.Of these,206 received PPI,51.94%had no indication for PPI,and 2 developed spontaneous peritonitis.Conclusion Clinicians are not clear about the risk-benefit ratio of PPI in patients with liver cirrhosis,and PPI may increase the risk of related complications.Further prospective data are urgently needed to increase the evidence on the indications and duration of PPI therapy in patients with cirrhosis.