中重型颅脑损伤患者继发应激性溃疡机制和防治策略研究进展

Pathogenic mechanism and preventive and therapeutic strategies for secondary stress ulcers in patients with moderate to severe traumatic brain injury

中重型颅脑损伤是复杂的危重临床疾病,容易继发应激性溃疡(stress ulcer,SU)值得关注.中重型颅脑损伤继发应激性溃疡的机制复杂,多与颅内压增高,迷走神经兴奋,儿茶酚胺分泌增多,胃黏膜灌注减少,H+逆向渗透有关.治疗颅脑损伤的同时,积极预防应激性溃疡是改善患者预后的关键.质子泵抑制剂(proton pump inhibitor,PPI)、组胺受体拮抗剂(histamine H2 receptor antagonists,H2RA)被广泛应用于应激性溃疡的预防和治疗,但是其预防效果和药物副作用方面还存在较大争议.应激性溃疡的发生涉及多种因素的综合作用,既往研究为临床提供了一定的参考价值,但是很难精准地指导临床应激性溃疡的科学防治,未来应依据大量循证医学证据制定应激性溃疡防治指南,明确干预时机,预防性用药适应症,形成规范化治疗.

Moderate to severe traumatic brain injury is a complex and critical clinical disease,which is prone to secondary stress ulcers(SU).The pathogenic mechanism of secondary stress ulcers in moderate to severe traumatic brain injury is complex and often related to increased intracranial pressure,excitation of the vagus nerve,increased secretion of catecholamines,decreased gastric mucosal perfusion,and H+reverse osmosis.While treating traumatic brain injury,actively preventing stress ulcers is the key to improving patient prognosis.Proton pump inhibitors(PPIs)and histamine receptor 2 antagonists(H2RAs)are widely used in the prevention and treatment of stress ulcers,but their preventive effects and drug side effects are still controversial.The occurrence of stress ulcers is a result of multiple factors.Previous research has provided certain reference value for clinical practice,but it is difficult to accurately guide the scientific prevention and treatment of stress ulcers in clinical practice.In the future,evidence-based medicine should be used to develop guidelines for the prevention and treatment of stress ulcers,clarify the timing of intervention,define indications for preventive medication,and formulate standardized treatment.