PICU应激性溃疡抑酸剂的规范应用

Rational use of acid suppressant for stress ulcer in PICU

应激相关的消化道黏膜病变是儿科重症监护病房常见的并发症,病变可进展为应激性溃疡,严重溃疡出血可导致死亡。目前对有应激性溃疡高危因素的危重儿童建议预防性抑酸治疗,最常用的抑酸剂是质子泵抑制剂和组胺2受体拮抗剂。然而过度的预防性抑酸治疗在儿科重症监护病房非常普遍,可增加医院获得性肺炎和艰难梭菌感染的风险。本文就儿科重症监护病房预防性抑酸治疗的现状及利弊进行分析,并探讨如何规范使用抑酸剂。

Stress-related digestive tract mucosal disease is a common complication in pediatric intensive care unit(PICU).It may progress to stress ulcer and severe ulcer bleeding,which may lead to death.Currently,stress ulcer prophylaxis is recommended for critically ill children with high risk factors for stress ulcer,and the most commonly used acid suppression drugs are proton pump inhibitor and histamine-2 receptor antagonist.However,excessive prophylactic acid suppression is common and can increase the risk of hospital-acquired pneumonia and clostridium difficile infection in PICU.This review aimed to analyze the advantages and disadvantages of preventive acid suppressant therapy and promote the rational use of acid suppressant in PICU.