Department of Internal Medicine Residency Program, Annenberg Conference Center, Lankenau Hospital, Wynnewood, PA 19096, USA.
J Crit Care. 2010 Jun;25(2):214-20. doi: 10.1016/j.jcrc.2009.05.014. Epub 2009 Aug 15.
Patients admitted to the intensive care unit (ICU) are susceptible to stress ulcers. We hypothesize that despite recommendations, stress ulcer prophylaxis (SUP) is still overused in the ICU and often continued after resolution of risk factors for bleeding.
We retrospectively studied all ICU admissions for 4 months. Risk factors for stress ulcer bleeding were collected. Patients were categorized into 4 groups: (1) >or=1 major risk factor; (2) >or=1 minor risk factors; (3) no risk factors; (4) preadmission use of acid-suppressive medication. The rate of SUP was calculated by group during ICU stay, on transfer from the ICU, and at hospital discharge.
Two hundred ten patients were studied. Of all the ICU admissions, 87.1% received SUP. Among patients with no risk factors, 68.1% were placed on prophylaxis on ICU admission; 60.4% continued on treatment upon transfer from the ICU; 31.0% were discharged home on an agent without a new indication.
Although judicious use of SUP in high-risk patients can decrease the incidence of gastrointestinal bleeding, inappropriate use may increase drug reactions, unnecessary hospital costs, and personal monetary burden. Our findings argue for improvement measures to reduce initial inpatient overuse of SUP and to prompt discontinuation before hospital discharge.
入住重症监护病房（ICU）的患者易发生应激性溃疡。我们假设，尽管有相关建议，但 ICU 中应激性溃疡预防（SUP）仍被过度使用，且常在出血风险因素消除后仍继续使用。
我们对 4 个月内所有 ICU 住院患者进行了回顾性研究。收集了应激性溃疡出血的风险因素。患者分为 4 组：（1）有≥1 个主要风险因素；（2）有≥1 个次要风险因素；（3）无风险因素；（4）入院前使用抑酸药物。在 ICU 住院期间、从 ICU 转出时和出院时，按组计算 SUP 的使用率。
研究了 210 例患者。所有 ICU 住院患者中，87.1%接受了 SUP。无风险因素的患者中，68.1%在 ICU 入院时开始预防治疗；60.4%在从 ICU 转出时继续治疗；31.0%出院时带药回家，而无新指征。
尽管在高危患者中合理使用 SUP 可降低胃肠道出血的发生率，但不适当的使用可能会增加药物反应、不必要的医院费用和个人经济负担。我们的研究结果表明，需要采取改进措施，以减少初始住院患者 SUP 的过度使用，并在出院前及时停药。
