Bailie George R, Mason Nancy A, Elder Stacey J, Andreucci Vittorio E, Greenwood Roger N, Akiba Takashi, Saito Akira, Bragg-Gresham Jennifer L, Gillespie Brenda W, Young Eric W
Albany College of Pharmacy, Albany, New York 12208, USA.
Hemodial Int. 2006 Apr;10(2):180-8. doi: 10.1111/j.1542-4758.2006.00092.x.
Little is known about proton pump inhibitor (PPI) or H(2) receptor antagonist (HA) prescription patterns or regarding use of predictors in hemodialysis patients. Proton pump inhibitor and HA prescribing patterns were investigated in 8628 hemodialysis patients from seven countries enrolled in the prospective, observational Dialysis Outcomes and Practice Patterns Study. Logistic regression examined predictors associated with PPI and HA use, adjusting for age, sex, country, time with end-stage renal disease, medications, 14 comorbid conditions, and the association between the number of comorbid conditions and the prescription of gastrointestinal (GI) medications. In a cross-section from February 1, 2000, 3.4% to 36.9% of patients received an HA and 0.8% to 26.9% took a PPI, depending upon the country. From 1996 to 2001, the prescription of HAs declined while PPI use increased. Facility use of HAs and PPIs ranged from 0% to 94% of patients. H2 receptor antagonist or PPI use was significantly and independently associated with age, narcotic use, corticosteroids, acetaminophen, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, selective serotonin reuptake inhibitors, coronary artery disease history, cardiovascular diseases other than hypertension or congestive heart failure, peripheral vascular disease, pulmonary disease, and GI bleed. Proton pump inhibitors or HAs were more likely to be prescribed in Italy, Spain, and the United Kingdom than in the United States. The odds of PPI prescription increased if serum phosphorus <5.5 mEq/L or serum albumin <3.5 g/dL. Prescription of GI medications was associated with many comorbidities and use of several medications. Extreme variability of prescription patterns suggests that there is no standard approach in treatment practices.
关于质子泵抑制剂（PPI）或H₂受体拮抗剂（HA）的处方模式，以及在血液透析患者中使用预测指标的情况，人们所知甚少。在一项前瞻性观察性的透析结果与实践模式研究中，对来自七个国家的8628例血液透析患者的质子泵抑制剂和HA处方模式进行了调查。采用逻辑回归分析与PPI和HA使用相关的预测指标，并对年龄、性别、国家、终末期肾病病程、药物、14种合并症以及合并症数量与胃肠道（GI）药物处方之间的关联进行了校正。在2000年2月1日的横断面研究中，根据国家不同，3.4%至36.9%的患者接受了HA治疗，0.8%至26.9%的患者服用了PPI。从1996年到2001年，HA的处方量下降，而PPI的使用量增加。各医疗机构中使用HA和PPI的患者比例从0%到94%不等。使用H₂受体拮抗剂或PPI与年龄、使用麻醉剂、使用皮质类固醇、对乙酰氨基酚、非甾体抗炎药、三环类抗抑郁药、选择性5-羟色胺再摄取抑制剂、冠心病病史、除高血压或充血性心力衰竭外的心血管疾病、外周血管疾病、肺部疾病以及胃肠道出血显著且独立相关。与美国相比，意大利、西班牙和英国更有可能开具质子泵抑制剂或HA。如果血清磷<5.5 mEq/L或血清白蛋白<3.5 g/dL，则开具PPI的几率会增加。胃肠道药物的处方与多种合并症以及多种药物的使用有关。处方模式的极大差异表明，治疗实践中没有标准方法。
