Kovacs Thomas O G, Jensen Dennis M
CURE Digestive Disease Research Center, VA Greater Los Angeles Healthcare System, Los Angeles, California 90073-1003, USA.
Drugs. 2008;68(15):2105-11. doi: 10.2165/00003495-200868150-00003.
Upper gastrointestinal (UGI) bleeding occurs frequently and results in substantial patient morbidity, mortality and medical expense. After initial resuscitation to stabilize the patient, carefully performed endoscopy provides an accurate diagnosis and can identify high-risk subgroups in ulcer patients who are likely to rebleed with medical therapy alone and would benefit most from endoscopic haemostasis. Several different pharmacological therapies have been used for patients with bleeding ulcers, including intravenous histamine H(2)-receptor antagonists, proton pump inhibitors, somatostatin and octreotide, and tranexamic acid. The results of several studies and meta-analyses favour high-dose, intravenous proton pump inhibitors, such as omeprazole or pantoprazole, after successful endoscopic haemostasis.For patients with ulcer bleeding and low-risk endoscopic stigmata, high-dose oral proton pump inhibitor therapy is suggested. Medical management with proton pump inhibitors is not a substitute for appropriate endoscopic therapy for patients with UGI bleeding and high-risk ulcer stigmata.
上消化道（UGI）出血频繁发生，会导致患者出现严重的发病情况、死亡以及产生高额医疗费用。在对患者进行初步复苏以使其病情稳定后，谨慎实施的内镜检查可提供准确诊断，并能识别溃疡患者中的高危亚组，这些患者仅接受药物治疗可能会再次出血，而内镜止血对其益处最大。已针对出血性溃疡患者使用了多种不同的药物治疗方法，包括静脉注射组胺H₂受体拮抗剂、质子泵抑制剂、生长抑素和奥曲肽，以及氨甲环酸。多项研究和荟萃分析的结果表明，在内镜止血成功后，高剂量静脉注射质子泵抑制剂，如奥美拉唑或泮托拉唑，效果更佳。对于溃疡出血且内镜下可见低风险征象的患者，建议采用高剂量口服质子泵抑制剂治疗。对于上消化道出血且溃疡有高风险征象的患者，使用质子泵抑制剂进行药物治疗并不能替代适当的内镜治疗。
