Wang Chih-Hung, Ma Matthew Huei-Ming, Chou Hao-Chang, Yen Zui-Shen, Yang Chih-Wei, Fang Cheng-Chung, Chen Shyr-Chyr
Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung Shan S Rd, Taipei, Taiwan 100.
Arch Intern Med. 2010 May 10;170(9):751-8. doi: 10.1001/archinternmed.2010.100.
High-dose proton pump inhibitors (PPIs) (80-mg bolus, followed by 8-mg/h continuous infusion for 72 hours) have been widely studied and used. However, to date no concrete evidence has shown that high-dose PPIs are more effective than non-high-dose PPIs.
We performed a literature search for randomized controlled trials that compared the use of high-dose PPIs vs non-high-dose PPIs in patients with bleeding peptic ulcer and determined their effects on rebleeding, surgical intervention, and mortality. Outcomes data were combined in a meta-analysis and were reported as odds ratios (ORs) with 95% confidence intervals (CIs).
A total of 1157 patients from 7 high-quality randomized studies were included in this meta-analysis. High-dose PPIs and non-high-dose PPIs did not differ in their effects on the rates of rebleeding (7 studies and 1157 patients; OR, 1.30; 95% CI, 0.88-1.91), surgical intervention (6 studies and 1052 patients; 1.49; 0.66-3.37), or mortality (6 studies and 1052 patients; 0.89; 0.37-2.13). Post hoc subgroup analyses revealed that summary outcomes measures were unaffected by severity of signs of recent hemorrhage at initial endoscopy, route of PPI administration, or PPI dose.
Compared with non-high-dose PPIs, high-dose PPIs do not further reduce the rates of rebleeding, surgical intervention, or mortality after endoscopic treatment in patients with bleeding peptic ulcer.
大剂量质子泵抑制剂（PPI）（80毫克推注，随后以8毫克/小时持续输注72小时）已得到广泛研究和应用。然而，迄今为止，尚无确凿证据表明大剂量PPI比非大剂量PPI更有效。
我们检索了比较大剂量PPI与非大剂量PPI用于消化性溃疡出血患者的随机对照试验，并确定它们对再出血、手术干预和死亡率的影响。结局数据进行荟萃分析，并报告为具有95%置信区间（CI）的比值比（OR）。
本荟萃分析纳入了来自7项高质量随机研究的1157例患者。大剂量PPI和非大剂量PPI在对再出血率（7项研究，1157例患者；OR，1.30；95%CI，0.88 - 1.91）、手术干预（6项研究，1052例患者；1.49；0.66 - 3.37）或死亡率（6项研究，1052例患者；0.89；0.37 - 2.13）的影响方面无差异。事后亚组分析显示，汇总结局指标不受初次内镜检查时近期出血迹象的严重程度、PPI给药途径或PPI剂量的影响。
与非大剂量PPI相比，大剂量PPI并不能进一步降低消化性溃疡出血患者内镜治疗后的再出血率、手术干预率或死亡率。
