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

发布时间：2018-11-18 09:51

【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, efficacy and safety of proton pump inhibitor (PPIs) prevention after glucocorticoid (GCs) administration in patients with (AECOPD) during acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods: from August 2013 to August 2015, the patients who were diagnosed with GCs during hospitalization in Tongji Medical College affiliated to Tongji Medical College, Huazhong University of Science and Technology, were collected, and the use of GCs and PPIs were analyzed. The risk factors of stress ulcer or gastrointestinal bleeding and the incidence of adverse drug reactions (ADR). Results: a total of 666 patients with GCs were enrolled, of whom 660 were treated with methylprednisolone succinate sodium for injection. 614 patients (92.19%) received an average course of treatment of (5.70 卤2.97) days at a dose of 30 渭 m 40 mg/d,GCs. The average course of treatment of PPIs was (8.60 卤4.55) days, of which 472 (70.76%) were treated with pantazol for injection (400.160 mg). / 663), and the average course of treatment was (8.60 卤4.55) days for 99.55%), PPIs. There were 403 cases (60.78%) with one or more risk factors of stress ulcer or gastrointestinal bleeding. Among them, 12 cases developed ADR, including 6 cases of stress ulcer and 3 cases of stool occult blood positive. There were 2 cases of stomach discomfort and 1 case of massive hemorrhage of digestive tract. Of the 3 patients without combined use of PPIs, 1 patient had a high risk factor for stress ulcer or gastrointestinal bleeding, and none of them had ADR.. Conclusion: the risk factors of stress ulcer or gastrointestinal bleeding should be evaluated clinically in patients with GCs and whether to use PPIs, to avoid the abuse of these drugs should be considered.
【作者单位】：华中科技大学同济医学院附属普爱医院呼吸内科;华中科技大学同济医学院附属普爱医院药学部;华中科技大学同济医学院附属协和医院呼吸内科;
【基金】：武汉市临床医学科研项目(No.WX16B11)
【分类号】：R563.9

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