Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Crit Care Med. 2010 Apr;38(4):1197-205. doi: 10.1097/CCM.0b013e3181d69ccf.
To examine the efficacy and safety of proton pump inhibitors in comparison with histamine-2 receptor antagonists for stress-related upper gastrointestinal bleeding prophylaxis among critical care patients.
PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov.
Randomized, controlled trials that directly compare proton pump inhibitors with histamine-2 receptor antagonists in prevention of stress-related upper gastrointestinal bleeding in intensive care unit patients published before May 30, 2008.
Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. The primary outcome was the incidence of stress-related upper gastrointestinal bleeding, and the secondary outcome measures were the incidence of pneumonia and intensive care unit mortality.
The random effect model was used to estimate the pooled risk difference between two treatment arms irrespective of drug, dosage, and route of administration.
We identified seven randomized, controlled trials with a total of 936 patients for planned comparison. The overall pooled risk difference (95% confidence interval; p value; I statistics) of stress-related upper gastrointestinal bleeding comparing proton pump inhibitors vs. histamine-2 receptor antagonists was -0.04 (95% confidence interval, -0.09-0.01; p = .08; I = 66%). In the sensitivity analysis, removing the Levy study significantly reduced the heterogeneity (from I = 66% to I = 26%) and shifted the overall risk difference closer to the null (pooled risk difference, -0.02; 95% confidence interval, -0.05-0.01; p = .19). There was no difference between proton pump inhibitors and histamine-2 receptor antagonists therapy in the risk of pneumonia and intensive care unit mortality, with pooled risk differences of 0.00 (95% confidence interval, -0.04-0.05; p = .86; I = 0%) and 0.02 (95% confidence interval, -0.04-0.08; p = .50; I = 0%), respectively.
This meta-analysis did not find strong evidence that proton pump inhibitors were different from histamine-2 receptor antagonists in terms of stress-related upper gastrointestinal bleeding prophylaxis, pneumonia, and mortality among patients admitted to intensive care units. Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted.
比较质子泵抑制剂与组胺 2 受体拮抗剂在预防重症监护患者应激性上消化道出血中的疗效和安全性。
PubMed、EMBASE、Cochrane 图书馆和 ClinicalTrials.gov。
直接比较质子泵抑制剂与组胺 2 受体拮抗剂预防重症监护病房患者应激性上消化道出血的随机对照试验，研究对象为 2008 年 5 月 30 日前发表的重症监护患者。
两名审查员独立应用选择标准、进行质量评估并提取数据。主要结果是应激性上消化道出血的发生率，次要结果测量指标是肺炎和重症监护病房死亡率。
使用随机效应模型，无论药物、剂量和给药途径如何，估计两组治疗之间的累积风险差异。
我们确定了 7 项共 936 例患者的随机对照试验进行计划比较。与组胺 2 受体拮抗剂相比，质子泵抑制剂治疗应激性上消化道出血的总体累积风险差异（95%置信区间；p 值；I 统计量）为-0.04（95%置信区间，-0.09 至 0.01；p =.08；I = 66%）。在敏感性分析中，去除 Levy 研究后，异质性显著降低（从 I = 66%降至 I = 26%），整体风险差异更接近零（累积风险差异，-0.02；95%置信区间，-0.05 至 0.01；p =.19）。质子泵抑制剂与组胺 2 受体拮抗剂治疗在肺炎和重症监护病房死亡率方面无差异，累积风险差异分别为 0.00（95%置信区间，-0.04 至 0.05；p =.86；I = 0%）和 0.02（95%置信区间，-0.04 至 0.08；p =.50；I = 0%）。
本荟萃分析没有发现强有力的证据表明质子泵抑制剂在预防重症监护病房患者应激性上消化道出血、肺炎和死亡率方面与组胺 2 受体拮抗剂有差异。由于试验数据有限，需要未来进行精心设计和强大的随机临床试验。
