Wilcox C Mel
Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Am J Cardiol. 2006 May 8;97(9A):17-22. doi: 10.1016/j.amjcard.2006.02.019.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most widely used classes of medications worldwide, available both through prescription and over the counter (OTC). Although these drugs are highly effective for pain, gastrointestinal (GI) complications may occur. Risk factors for GI complications from NSAIDs have been well studied, and the highest risk exists among the elderly and patients with a history of GI bleeding or complications. The increasingly widespread use of aspirin for both primary and secondary cardiovascular prophylaxis has also drawn attention to the potential increase in GI complications. Several strategies may minimize NSAID-mediated GI complications, including the use of drugs that do not injure the gut, such as acetaminophen or a low-dose opiate. The cyclooxygenase-2 (COX-2) inhibitors, which cause approximately 50% fewer GI complications than traditional NSAIDs, may also be used, although their cardiovascular safety has recently come into question. Antacid therapy with proton pump inhibitors (PPIs) may also be used to reduce NSAID-related dyspepsia and upper GI complications. Misoprostol is also effective in preventing NSAID-related complications, but is not as well tolerated. In any patient, the risk-benefit ratio must be assessed to determine the appropriate therapies to minimize GI complications resulting from daily aspirin therapy.
非甾体抗炎药（NSAIDs）是全球使用最广泛的药物类别之一，有处方药和非处方药（OTC）两种。尽管这些药物对疼痛非常有效，但可能会出现胃肠道（GI）并发症。NSAIDs引起GI并发症的风险因素已得到充分研究，老年人以及有GI出血或并发症病史的患者风险最高。阿司匹林在心血管疾病一级和二级预防中的使用日益广泛，这也引起了人们对GI并发症潜在增加的关注。几种策略可以将NSAID介导的GI并发症降至最低，包括使用不损伤肠道的药物，如对乙酰氨基酚或低剂量阿片类药物。环氧化酶-2（COX-2）抑制剂引起的GI并发症比传统NSAIDs少约50%，也可使用，尽管其心血管安全性最近受到质疑。质子泵抑制剂（PPI）的抗酸治疗也可用于减少与NSAID相关的消化不良和上消化道并发症。米索前列醇在预防NSAID相关并发症方面也有效，但耐受性较差。对于任何患者，都必须评估风险效益比，以确定适当的治疗方法，将每日阿司匹林治疗引起的GI并发症降至最低。
