目的 比较质子泵抑制药(proton pump inhibitors,PPI)和H2受体拮抗药(histamine-2-receptor antagonists,H2RAs)预防危重患者应激性溃疡的有效性和安全性。方法 对Cochrane图书馆,PubMed,Embase,ScienceDirect数据库,中国知网,中国生物医学文献数据库进行检索。只纳入PPI和H2RA预防应激性溃疡的随机对照(RCT)实验进行Meta分析,统计指标包括临床消化道大出血,明显上消化道出血,医源性肺炎,死亡率,ICU住院时间,艰难梭菌感染。结果 纳入9篇文献,其中高质量文献3篇,共报道消化道大出血患者1151例,结果表明预防性应用PPI与H2RA相比,可以降低临床胃肠道大出血的风险(RR=0.39;95%CI=0.21-0.71;P=0.002;I2=0%)。结论 应用PPI预防应激性溃疡效果要优于H2RA,可以降低消化道大出血和明显上消化道出血的风险,同时未增加肺炎风险、死亡率和ICU住院时间。两药对艰难梭菌感染的影响尚不明确。
Abstract
Objective To compare the curative effect and safety of proton pump inhibitors (PPI) and histamine-2-receptor antagonists (H2RAs) when used to prevent stress ulcer prophylaxis in critically ill patients.Methods Randomized controlled trials (RCTs) of PPI vs H2RA for stress ulcer prophylaxis in patients in critical condition were retrieved from the Cochrane library, PubMed, Embase, Science Direct,CNKI and CMB databases. Key indexes included gastrointestinal (GI) bleeding, iatrogenic pneumonia, Clostridium difficile infection, mortality and length of stay in the ICU.Results Prophylactic application of PPIs can reduce the risk of clinical gastrointestinal bleeding and upper gastrointestinal bleeding compared with H2RA.Conclusions PPIs are superior to H2RAs in preventing GI bleeding without significantly increasing the risk of pneumonia or mortality. However,their impact on Clostridium difficile infections remains uncertain.
关键词
质子泵抑制剂 /
H2受体拮抗剂 /
应激性溃疡 /
Meta分析
Key words
proton pump inhibitor /
histamine-2-receptor antagonist /
stress ulcer /
meta-analysis
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