Department of Colorectal and Anal Surgery, First Affiliated Hospital, Guangxi Medical University, 22 Shuangyong Road, Nanning 530021, Guangxi, PR China.
Crit Care. 2010;14(5):R194. doi: 10.1186/cc9312. Epub 2010 Oct 29.
We conducted a meta-analysis in order to investigate the effect of histamine-2-receptor antagonists (H2RA) versus sucralfate on stress ulcer prophylaxis in mechanically ventilated patients in the intensive care unit (ICU).
A systematic literature search of Medline, EMBASE, Cochrane Central Register of Controlled Trials (1966 to January 2010) was conducted using specific search terms. A review of Web of Science and a manual review of references were also performed. Eligible studies were randomized control trials (RCTs) that compared H2RA and sucralfate for the prevention of stress ulcer in mechanically ventilated patients. Main outcome measures were rates of overt bleeding, clinically important gastrointestinal (GI) bleeding, ventilator-associated pneumonia, gastric colonization and ICU mortality.
Ten RCTs with 2,092 participants on mechanical ventilation were identified. Meta-analysis showed there was a trend toward decreased overt bleeding when H2RA was compared with sucralfate (OR = 0.87, 95% CI: 0.49 to 1.53). A total of 12 clinically important GI bleeding events occurred among 667 patients (1.8%) in the H2RA group compared with 26 events among 673 patients (3.9%) in the sucralfate groups. Prophylaxis with sucralfate decreased the incidence of gastric colonization (OR = 2.03, 95% CI: 1.29 to 3.19) and ventilator-associated pneumonia (OR = 1.32, 95% CI: 1.07 to 1.64). Subgroup analysis showed H2RA was not superior to sucralfate in reducing early-onset pneumonia (OR = 0.62, 95%CI: 0.36 to 1.07) but had a higher late-onset pneumonia rate (OR = 4.36, 95%CI: 2.09 to 9.09) relative to sucralfate. No statistically significant reduction was observed in mortality of ICU between groups (OR = 1.08, 95% CI: 0.86 to 1.34).
In patients with mechanical ventilation, H2RA resulted in no differential effectiveness in treating overt bleeding, but had higher rates of gastric colonization and ventilator-associated pneumonia. Additional RCTs of stress ulcer prophylaxis with H2RA and sucralfate are needed to establish the net benefit and risks of adverse effect in mechanically ventilated patients.
我们进行了一项荟萃分析，旨在研究组胺 2 受体拮抗剂（H2RA）与硫糖铝对机械通气患者 ICU 应激性溃疡预防的影响。
使用特定的检索词，对 Medline、EMBASE、Cochrane 对照试验中心注册库（1966 年至 2010 年 1 月）进行了系统的文献检索。还对 Web of Science 进行了综述和对参考文献进行了手动综述。合格的研究是比较 H2RA 和硫糖铝预防机械通气患者应激性溃疡的随机对照试验（RCT）。主要观察指标为显性出血、临床相关胃肠道（GI）出血、呼吸机相关性肺炎、胃定植和 ICU 死亡率的发生率。
确定了 10 项涉及 2092 名机械通气患者的 RCT。荟萃分析显示，与硫糖铝相比，H2RA 可降低显性出血的发生率（OR=0.87，95%CI：0.49 至 1.53）。H2RA 组的 667 例患者中有 12 例（1.8%）发生了 12 例临床相关 GI 出血事件，而硫糖铝组的 673 例患者中有 26 例（3.9%）发生了出血事件。预防性使用硫糖铝可降低胃定植（OR=2.03，95%CI：1.29 至 3.19）和呼吸机相关性肺炎（OR=1.32，95%CI：1.07 至 1.64）的发生率。亚组分析显示，H2RA 在降低早发性肺炎方面并不优于硫糖铝（OR=0.62，95%CI：0.36 至 1.07），但晚发性肺炎的发生率较高（OR=4.36，95%CI：2.09 至 9.09）。两组间 ICU 死亡率无统计学差异（OR=1.08，95%CI：0.86 至 1.34）。
在机械通气患者中，H2RA 治疗显性出血的效果无差异，但胃定植和呼吸机相关性肺炎的发生率较高。需要进一步的 RCT 来评估 H2RA 和硫糖铝预防应激性溃疡的净效益和不良反应风险。
