Carroll T A, Morris K, Rawluk D
National Neurosurgical Unit, Beaumont Hospital, Dublin, Ireland.
Br J Neurosurg. 1997 Feb;11(1):39-42. doi: 10.1080/02688699746672.
The indications for gastroprotection concurrent with corticosteroid use or as prophylaxis for stress ulceration in the neurosurgical intensive care unit remain unclear. The purpose of this study was to determine to what extent gastroprotection is practised in neurosurgical units in the British Isles. Data were obtained by questionnaire circulated at the end of 1988 and 1994. Of 92 surgeons who replied in 1988, 49 routinely used a gastroprotective agent with corticosteroids and 47 in patients at risk of stress ulceration. This compares with 63 out of 89 surgeons using a gastroprotective agent with steroid administration and 60 using prophylaxis for stress ulceration in 1994. The gastroprotective agent of choice in 1988 was an H2 antagonist (76) followed by antacids (36). In 1994, it was again an H2 antagonist (69), but sucralfate (15) was now the second most common agent used. The number of reported peptic ulcer complications among those surgeons who did not routinely use gastroprotective agents was no higher than those who did. Our findings indicate an increase in the administration of gastroprotective agents within neurosurgery. However, the use of H2 antagonists in the intensive care unit and the use of gastroprotective agents with corticosteroids may not be warranted.
在神经外科重症监护病房中，与使用皮质类固醇同时进行胃保护或作为应激性溃疡预防措施的指征仍不明确。本研究的目的是确定在不列颠群岛的神经外科病房中胃保护措施的实施程度。数据通过在1988年底和1994年底发放的问卷获得。1988年回复的92位外科医生中，49位常规将胃保护剂与皮质类固醇一起使用，47位在有应激性溃疡风险的患者中使用。相比之下，1994年89位外科医生中有63位在使用类固醇时使用胃保护剂，60位使用应激性溃疡预防措施。1988年首选的胃保护剂是H2拮抗剂（76例），其次是抗酸剂（36例）。1994年，仍是H2拮抗剂（69例），但硫糖铝（15例）现在是第二常用的药物。在那些不常规使用胃保护剂的外科医生中，报告的消化性溃疡并发症数量并不高于使用胃保护剂的医生。我们的研究结果表明神经外科中胃保护剂的使用有所增加。然而，在重症监护病房使用H2拮抗剂以及将胃保护剂与皮质类固醇一起使用可能没有必要。
