Midwestern University, College of Pharmacy-Glendale, 19555 N 59th Avenue, Glendale, AZ, 85308, USA.
Honor Health- John C. Lincoln Medical Center, Phoenix, AZ, USA.
Neurocrit Care. 2018 Dec;29(3):344-357. doi: 10.1007/s12028-017-0447-y.
Stress ulcer prophylaxis (SUP) with acid-suppressive drug therapy is widely utilized in critically ill patients following neurologic injury for the prevention of clinically important stress-related gastrointestinal bleeding (CIB). Data supporting SUP, however, largely originates from studies conducted during an era where practices were vastly different than what is considered routine by today's standard. This is particularly true in neurocritical care patients. In fact, the routine provision of SUP has been challenged due to an increasing prevalence of adverse drug events with acid-suppressive therapy and the perception that CIB rates are sparse. This narrative review will discuss current controversies with SUP as they apply to neurocritical care patients. Specifically, the pathophysiology, prevalence, and risk factors for CIB along with the comparative efficacy, safety, and cost-effectiveness of acid-suppressive therapy will be described.
应激性溃疡预防（SUP）使用抑酸药物治疗在神经损伤后的重症患者中广泛应用，以预防临床上重要的应激相关胃肠道出血（CIB）。然而，支持 SUP 的数据主要来源于在与当今标准相差甚远的时代进行的研究。在神经重症患者中尤其如此。事实上，由于抑酸治疗的不良药物事件发生率增加以及 CIB 发生率稀少的认知，SUP 的常规应用已受到挑战。本综述将讨论 SUP 在神经重症患者中的当前争议。具体而言，将描述 CIB 的病理生理学、患病率和危险因素，以及抑酸治疗的比较疗效、安全性和成本效益。
