双盲安慰剂对照临床试验预防奥美拉唑在手术治疗急性胸腰椎间盘突岀的狗。
Double-blinded placebo-controlled clinical trial of prophylactic omeprazole in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion.
机构信息
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA.
Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas, USA.
出版信息
J Vet Intern Med. 2023 Mar;37(2):586-597. doi: 10.1111/jvim.16642. Epub 2023 Feb 11.
BACKGROUND
Proton pump inhibitors are administered prophylactically in dogs treated surgically for acute thoracolumbar intervertebral disc extrusion (TL-IVDE). However, their efficacy in decreasing gastrointestinal (GI) complications is unknown.
HYPOTHESIS
Omeprazole does not decrease the frequency of GI complications compared to placebo in dogs treated surgically for acute TL-IVDE.
ANIMALS
Thirty-seven client-owned dogs undergoing hemilaminectomy for acute TL-IVDE.
METHODS
Randomized double-blinded placebo-controlled prospective clinical trial. Dogs received PO placebo or omeprazole at 1 mg/kg q12h for 5 days during hospitalization. Development of GI signs (e.g., diarrhea, vomiting, regurgitation, hematochezia, melena) was recorded daily. Clinicopathologic testing performed during hospitalization and at 2 and 4-week re-evaluations included: fecal occult blood, PCV, blood urea nitrogen/creatinine ratio, fecal calprotectin, canine pancreatic lipase immunoreactivity and fecal alpha-1 proteinase inhibitor concentrations. Omeprazole and placebo groups were compared using chi-squared or Fisher's exact tests.
RESULTS
Gastrointestinal signs developed in 10/20 (50%) dogs in the omeprazole group and in 7/17 (41%) dogs in the placebo group (P = .59). Diarrhea was common (8/20 omeprazole, 5/17 placebo), hematochezia was rare (1/20 omeprazole, 1/17 placebo); melena was not observed. Clinicopathologic evidence suggestive of bleeding was present in 9/20 dogs treated with omeprazole and in 11/17 dogs that received placebo (P = .23). Fecal occult blood positivity was more common in dogs with GI signs (P = .03). Canine pancreatic lipase immunoreactivity was higher during hospitalization compared to re-evaluations (P = .01).
CONCLUSIONS AND CLINICAL IMPORTANCE
Short-term, prophylactic omeprazole treatment did not decrease clinically detectable GI complications in dogs with acute TL-IVDE.
背景
在接受手术治疗急性胸腰椎间盘突出症（TL-IVDE）的犬中，预防性使用质子泵抑制剂。然而，其减少胃肠道（GI）并发症的效果尚不清楚。
假设
与安慰剂相比，奥曲肽不能降低接受手术治疗急性 TL-IVDE 的犬的 GI 并发症发生率。
动物
37 只接受半椎板切除术治疗急性 TL-IVDE 的患犬。
方法
随机、双盲、安慰剂对照的前瞻性临床试验。犬在住院期间每天接受 PO 安慰剂或奥曲肽 1mg/kg，q12h，共 5 天。每天记录 GI 症状（如腹泻、呕吐、反流、血便、黑便）的发展情况。住院期间和 2 周及 4 周复查时进行临床病理检测，包括粪便潜血、PCV、血尿素氮/肌酐比值、粪便钙卫蛋白、犬胰腺脂肪酶免疫反应和粪便α-1 蛋白酶抑制剂浓度。使用卡方检验或 Fisher 确切概率法比较奥曲肽组和安慰剂组。
结果
奥曲肽组 20 只犬中有 10 只（50%）和安慰剂组 17 只犬中有 7 只（41%）出现 GI 症状（P=0.59）。腹泻很常见（奥曲肽组 8/20，安慰剂组 5/17），血便少见（奥曲肽组 1/20，安慰剂组 1/17）；未观察到黑便。接受奥曲肽治疗的 20 只犬中有 9 只和接受安慰剂的 17 只犬中有 11 只存在提示出血的临床病理证据（P=0.23）。有 GI 症状的犬粪便潜血阳性更常见（P=0.03）。与复查时相比，犬胰腺脂肪酶免疫反应在住院期间更高（P=0.01）。
结论和临床意义
短期预防性奥曲肽治疗不能降低急性 TL-IVDE 犬的临床可检测胃肠道并发症。
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