某院应用糖皮质激素的AECOPD患者预防使用质子泵抑制剂的调查分析
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篇名: 某院应用糖皮质激素的AECOPD患者预防使用质子泵抑制剂的调查分析
TITLE:
摘要: 目的:探讨慢性阻塞性肺疾病急性发作期(AECOPD)患者应用糖皮质激素(GCs)后预防使用质子泵抑制剂(PPIs)的必要性、有效性及安全性。方法:收集2013年8月-2015年8月在华中科技大学同济医学院附属普爱医院诊断为AECOPD、住院期间应用了GCs的患者,统计其GCs和PPIs的使用情况、应激性溃疡或胃肠道出血风险高危因素和药品不良反应(ADR)发生情况。结果:共纳入了666例GCs治疗患者,其中660例使用注射用甲泼尼龙琥珀酸钠,614例(92.19%)使用剂量为30~40 mg/d,GCs平均使用疗程为(5.70±2.97)d。联合使用PPIs的患者663例(99.55%),PPIs平均使用疗程为(8.60±4.55)d,其中472例(70.76%)使用注射用泮托拉唑(剂量40~160 mg)。663例使用PPIs的患者中,有403例(60.78%)存在1个及以上应激性溃疡或胃肠道出血风险高危因素,其中有12例患者发生了ADR,包括应激性溃疡6例、大便潜血阳性3例、胃部不适2例和消化道大出血1例;3例未联合使用PPIs的患者中,1例存在应激性溃疡或胃肠道出血风险高危因素,均未发生ADR。结论:临床上对于应用了GCs的患者,应进行应激性溃疡或胃肠道出血高危因素风险评估,再考虑是否使用PPIs,避免此类药物的滥用。
ABSTRACT: OBJECTIVE: To investigate the necessity, effectiveness and safety of prophylactic application of proton pump inhibitors (PPIs) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after glucocorticoids (GCs) use. METHODS: The patients diagnosed as AECOPD receiving GCs during hospitalization were collected from Pu’ai Hospital of Tongji Medical College, Huazhong University of Science and Technology during Aug. 2013-Aug. 2015. The application of GCs and PPIs, risk factor of stress ulcer or gastrointestinal bleeding, the occurrence of ADR were analyzed statistically. RESUITS: A total of 666 patients using GCs were included, among which 660 patients were given Methylprednisolone for injection. The dose of GCs of 614 cases (92.19%) were 30-40 mg/d, and average treatment course of GCs was (5.70±2.97) d. Combined use of PPIs occurred in 663 cases (99.55%) and average duration of PPIs was (8.60±4.55)d, among which 472 cases (70.76%) received Pantoprazole for injection (40-160 mg). Among 663 patients receiving PPIs, more than one risk factor of stress ulcer or gastrointestinal bleeding were found in 403 cases (60.78%), and 12 of them suffered from ADR including 6 cases of stress ulcer, 3 cases of positive dccult blood, 2 cases of stomach discomfort and 1 case of gastrointestinal massive bleeding. Among 3 patients without using PPIs, risk factor of stress ulcer or gastrointestinal bleeding was found in one case, but ADR was not found. CONCLUSIONS: For those patients receiving GCs, PPIs selection should be based on risk factor evaluation of stress ulcer or gastrointestinal bleeding, to avoid abuse of this type.
期刊: 2017年第28卷第2期
作者: 胡建武,苏艳伟,杜丽芬,卢桥发,金阳
AUTHORS: HU Jianwu,SU Yanwei,DU Lifen,LU Qiaofa,JIN Yang
关键字: 慢性阻塞性肺疾病急性发作期;糖皮质激素;质子泵抑制剂;应激性溃疡;胃肠道出血
KEYWORDS: Acute exacerbation of chronic obstructive pulmonary disease; Glucocorticoids; Proton pump inhibitor; Stress ulcer; Gastrointestinal bleeding
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