Murphy Catherine E, Stevens Alison M, Ferrentino Nicholas, Crookes Bruce A, Hebert James C, Freiburg Carter B, Rebuck Jill A
Department of Pharmacotherapy, Fletcher Allen Health Care, Burlington, Vermont, USA.
Pharmacotherapy. 2008 Aug;28(8):968-76. doi: 10.1592/phco.28.8.968.
To determine the frequency with which patients who begin to receive stress ulcer prophylaxis in the surgical intensive care unit (SICU) are discharged receiving inappropriate acid suppressive therapy (AST).
Prospective, observational evaluation. Setting. Level 1 trauma center and academic tertiary care hospital.
A total of 248 consecutive adult patients admitted to the SICU during a 6-month period who began to receive AST with a proton pump inhibitor or histamine(2)-receptor antagonist.
In most patients (237 [95.6%] of 248), initiation of AST was associated with one or more risk factors for gastrointestinal bleeding. Continuation of AST during hospitalization outside the SICU occurred in 215 patients (86.7%). Sixty patients (24.2%) were discharged from the hospital receiving AST: 52 patients (21.0%) went to skilled nursing facilities or rehabilitation centers, and eight (3.2%) were discharged home. Compared with those whose AST was discontinued in the hospital, patients who continued to receive AST after hospital discharge required extended mechanical ventilation (p=0.001), had twice as many risk factors for gastrointestinal bleeding (p<0.001), were frequently discharged with anticoagulant therapy (p<0.001), exhibited longer hospital and SICU stays (p<0.001), and more frequently demonstrated Glasgow Coma Scale scores of 8 or lower and/or had head injury (p<0.001), hepatic failure (p=0.004), and major trauma (p=0.049). Evaluation of continuation of AST during hospitalization revealed that only 7.4% (16/215) of patients at SICU transfer and 5.0% (3/60) of patients at hospital discharge had a compelling risk factor to continue AST as demonstrated by a coagulopathy at discharge; no patients required mechanical ventilation at hospital discharge.
Most patients inappropriately continued to receive stress ulcer prophylaxis during post-SICU hospitalization. Presence of risk factors for stress ulcer-related gastrointestinal bleeding at SICU admission appears to influence continuation of AST after discharge from the hospital. A low percentage (3.2%) of patients was discharged home receiving inappropriate AST, yet overall, few study patients demonstrated a compelling risk factor for continuation of AST.
确定在外科重症监护病房（SICU）开始接受应激性溃疡预防治疗的患者出院时接受不适当抑酸治疗（AST）的频率。
前瞻性观察性评估。地点：一级创伤中心和学术性三级护理医院。
在6个月期间连续入住SICU并开始接受质子泵抑制剂或组胺2受体拮抗剂进行AST治疗的248例成年患者。
大多数患者（248例中的237例[95.6%]）开始接受AST与一个或多个胃肠道出血风险因素相关。215例患者（86.7%）在SICU以外的住院期间继续接受AST治疗。60例患者（24.2%）出院时仍在接受AST治疗：52例患者（21.0%）前往专业护理机构或康复中心，8例（3.2%）出院回家。与在医院停止接受AST治疗的患者相比，出院后继续接受AST治疗的患者需要更长时间的机械通气（p = 0.001），胃肠道出血风险因素多一倍（p < 0.001），出院时经常接受抗凝治疗（p < 0.001），住院和在SICU停留时间更长（p < 0.001），更频繁地出现格拉斯哥昏迷量表评分为8分或更低和/或有头部损伤（p < 0.001）、肝功能衰竭（p = 0.004）和严重创伤（p = 0.049）。对住院期间AST治疗持续情况的评估显示，转出SICU时只有7.4%（16/215）的患者和出院时5.0%（3/60）的患者有令人信服的风险因素需要继续接受AST治疗，如出院时的凝血功能障碍；出院时没有患者需要机械通气。
大多数患者在SICU后的住院期间不恰当地继续接受应激性溃疡预防治疗。SICU入院时存在应激性溃疡相关胃肠道出血的风险因素似乎会影响出院后AST治疗的持续情况。出院回家仍接受不适当AST治疗的患者比例较低（3.2%），但总体而言，很少有研究患者表现出继续接受AST治疗的令人信服的风险因素。
