Devlin J W, Ben-Menachem T, Ulep S K, Peters M J, Fogel R P, Zarowitz B J
Department of Pharmacy Services, Henry Ford Hospital, Detroit, MI, USA.
Ann Pharmacother. 1998 Sep;32(9):869-74. doi: 10.1345/aph.18080.
To measure changes in the proportion of medical intensive care unit (MICU) patients prescribed pharmacologic stress ulcer prophylaxis therapy over a 4-year period in relation to the incidence of stress-related ulceration detected by endoscopy at our institution.
Retrospective 4-year review of pharmacy and endoscopy databases.
A 35-bed MICU.
Patients (n = 2941) admitted to the MICU for longer than 24 hours, between January 1, 1993, and December 31, 1996, without acute gastrointestinal hemorrhage on admission.
Records were reviewed to identify patients prescribed pharmacologic stress ulcer prophylaxis (> 24 h of sucralfate or a histamine2-receptor antagonist [H2RA]), and patients with evidence of stress ulceration during endoscopy.
The number of patients per year receiving stress ulcer prophylaxis significantly (p < 0.001) decreased between 1993 and 1996: 1993, 492/693 (71%); 1994, 478/798 (60%); 1995, 295/670 (44%); 1996, 164/780 (21%). There was no difference between years in the median duration of stress ulcer prophylaxis therapy or the proportion of patients receiving sucralfate versus H2RA therapy. There was no difference (p = 0.91) between years in the annual incidence of definite or possible stress-related ulceration: 1993, 6/693 (0.87%); 1994, 5/798 (0.63%); 1995, 6/670 (0.90%); 1996, 5/780 (0.64%).
The incidence of endoscopically proven stress-related ulceration has remained unchanged over the past 4 years in our MICU despite significantly fewer patients receiving pharmacologic stress ulcer prophylaxis therapy.
衡量在4年期间，接受药物性应激性溃疡预防治疗的医学重症监护病房（MICU）患者比例的变化，及其与本院通过内镜检查发现的应激相关溃疡发生率的关系。
对药房和内镜检查数据库进行为期4年的回顾性研究。
拥有35张床位的MICU。
1993年1月1日至1996年12月31日期间入住MICU超过24小时且入院时无急性胃肠道出血的患者（n = 2941）。
查阅记录以确定接受药物性应激性溃疡预防治疗（硫糖铝治疗超过24小时或使用组胺2受体拮抗剂[H2RA]）的患者，以及在内镜检查时有应激性溃疡证据的患者。
1993年至1996年期间，每年接受应激性溃疡预防治疗的患者数量显著减少（p < 0.001）：1993年，492/693（71%）；1994年，478/798（60%）；1995年，295/670（44%）；1996年，164/780（21%）。各年份间应激性溃疡预防治疗的中位持续时间或接受硫糖铝与H2RA治疗的患者比例无差异。各年份间明确或可能的应激相关溃疡年发病率无差异（p = 0.91）：1993年，6/693（0.87%）；1994年，5/798（0.63%）；1995年，6/670（0.90%）；1996年，5/780（0.64%）。
在过去4年中，尽管接受药物性应激性溃疡预防治疗的患者显著减少，但本院MICU经内镜证实的应激相关溃疡发生率保持不变。
