Crit Care Med:泮托拉唑能预防重症患者应激性溃疡的发生吗?一项随机临床试验和Meta分析

2017-06-23 MedSci MedSci原创

随着重症患者上消化道溃疡出血的发生频率增加,质子泵抑制剂的使用有可能和难辨梭状芽孢杆菌感染以及呼吸机相关性肺炎的发生逐渐上升有关。重新评估预防应激性溃疡大型试的可行性,明确重症患者不使用质子泵抑制剂是否安全有效。

随着重症患者上消化道溃疡出血的发生频率增加,质子泵抑制剂的使用有可能和难辨梭状芽孢杆菌感染以及呼吸机相关性肺炎的发生逐渐上升有关。本研究目的为重新评估预防应激性溃疡大型试验的可行性,明确重症患者不使用质子泵抑制剂预防应激性溃疡是否安全有效。

在10个ICU中,我们随机将成年ICU机械通气时间≥48小时的患者分为每日接受40mg泮托拉唑治疗组和安慰剂对照组。近期有消化道出血、双抗治疗、必须使用质子泵抑制剂、接受大于一种抑酸剂治疗的患者将不被纳入试验。患者、家属、医师、研究人员互相双盲。我们还对类似的试验进行了系统回顾和meta分析。

来自加拿大、沙特阿拉伯、澳大利亚10个医学中心的91名患者(泮托拉唑组49名,安慰剂组42名)将被纳入试验。试验结果显示:泮托拉唑组发生上消化道出血率为6.1%,安慰剂组为4.8%(p=1.0);泮托拉唑组呼吸机相关性肺炎发生率为20.4%,安慰剂组24%(p=0.58);泮托拉唑组难辨梭状芽孢杆菌感染率为4.1%,安慰剂组为2.4%(p=1.0)。我们对5个泮托拉唑和安慰剂对比的试验(604名患者)进行meta分析,泮托拉唑组和安慰剂组在上消化道出血风险、感染、死亡率上并无明显差别。

所以得出结论:对于预防应激性溃疡的途径,更大型的试验是具有可行性的、安全的。尽管此研究结果不是很明确,但是上消化道出血风险并没有不断的上升,质子泵抑制剂和呼吸机相关性肺炎以及难辨梭状芽孢杆菌感染的关系也并不明确。

原始出处:

Alhazzani W1, Guyatt G, et al. Withholding Pantoprazole for Stress Ulcer Prophylaxis in Critically Ill Patients: A Pilot Randomized Clinical Trial and Meta-Analysis. Crit Care Med. 2017 Jul;45(7):1121-1129. doi: 10.1097/CCM.0000000000002461.

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    2017-12-20 柳叶一刀
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    2017-12-28 一闲
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    2017-06-30 大爰

    学习并分享!!

    0

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Crit Care Med:停用泮托拉唑预防危重病患者应激性溃疡可行吗?

该研究的结果支持了进行一个更大的试验来评估停止应激性溃疡预防治疗安全性的可行性。虽然该结果并不精确,但上消化道出血风险并没有明显增加,质子泵抑制剂对呼吸机相关性肺炎和难辨梭状芽孢杆菌的影响仍不清楚。