Grube Rebekah R Arthur, May D Byron
School of Pharmacy, Campbell University, Durham, NC, USA.
Am J Health Syst Pharm. 2007 Jul 1;64(13):1396-400. doi: 10.2146/ajhp060393.
A review is presented of the evidence behind the current use of therapies for the prevention of stress-related mucosal disease and bleeding in the nonintensive care unit (ICU), general medicine population.
The use of proton pump inhibitors and histamine H2-receptor antagonists for the prevention of stress ulcers has been well-defined in critical care patients. In 1999, the American Society of Health-System Pharmacists (ASHP) published guidelines on the use of stress ulcer prophylaxis in medical, surgical, respiratory, and pediatric ICU patients. In recent years, the practice of stress ulcer prophylaxis has become increasingly more common in general medicine patients, with little to no evidence to support it. Multiple risk factors have been identified for the development of stress ulcers, such as major trauma, severe head injury, multiple organ failure, burns covering more than 25-30% of the body, and major surgical procedures. Multiple studies have demonstrated the overuse of acid-suppressive therapy (AST), with as many as 71% of patients admitted to the hospital receiving some form of treatment. While many practitioners view AST to be harmless, its use is not without risks. Subsequently, a significant number of patients are discharged home on these medications, increasing economic cost and potentially increasing the risk of pneumonia or Clostridium difficile-associated disease.
AST is commonly misused in hospitals, with as many as 71% of patients in general medicine wards receiving some sort of AST without an appropriate indication. Anticoagulant therapy has been identified as a risk factor for GI bleeding in hospitalized patients, but prophylaxis with AST has not been found to lower that risk. Although PPIs, H2-antagonists, and antacids are often viewed as safe, patients--particularly those with complicated disease states and complex drug regimens--should not be unduly exposed to the adverse effects and drug interactions associated with those agents. Many such patients treated with the drugs while hospitalized continue to receive AST as outpatients. The cost of inappropriate stress ulcer prophylaxis in medicine patients was found in one trial to exceed $111,000 for one year. The use of AST for the prevention of stress ulcers in general medicine patients is currently not recommended or supported in the clinical literature.
对当前在非重症监护病房（ICU）的普通内科患者中用于预防应激相关黏膜疾病和出血的治疗方法背后的证据进行综述。
在重症患者中，使用质子泵抑制剂和组胺H2受体拮抗剂预防应激性溃疡已有明确规定。1999年，美国卫生系统药师协会（ASHP）发布了关于在内科、外科、呼吸科和儿科ICU患者中使用应激性溃疡预防措施的指南。近年来，应激性溃疡预防措施在普通内科患者中的应用越来越普遍，但几乎没有证据支持这种做法。已确定多种应激性溃疡发生的危险因素，如严重创伤、重度颅脑损伤、多器官功能衰竭、烧伤面积超过身体的25% - 30%以及大型外科手术。多项研究表明存在酸抑制治疗（AST）的过度使用情况，多达71%的住院患者接受了某种形式的治疗。虽然许多从业者认为AST无害，但其使用并非没有风险。随后，大量患者出院时仍在服用这些药物，这增加了经济成本，并可能增加肺炎或艰难梭菌相关疾病的风险。
AST在医院中普遍被滥用，普通内科病房多达71%的患者在没有适当指征的情况下接受了某种AST治疗。抗凝治疗已被确定为住院患者发生胃肠道出血的危险因素，但未发现使用AST进行预防可降低该风险。尽管质子泵抑制剂、H2拮抗剂和抗酸剂通常被视为安全药物，但患者——尤其是那些患有复杂疾病状态和复杂药物治疗方案的患者——不应过度暴露于与这些药物相关的不良反应和药物相互作用中。许多此类住院时接受这些药物治疗的患者出院后仍作为门诊患者继续接受AST治疗。在一项试验中发现，普通内科患者不适当的应激性溃疡预防措施的费用一年超过111,000美元。目前，临床文献不推荐或支持在普通内科患者中使用AST预防应激性溃疡。
