中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2010年
4期
221-225
,共5页
周峻峰%万献尧%黄伟%韩丽丽
週峻峰%萬獻堯%黃偉%韓麗麗
주준봉%만헌요%황위%한려려
应激性溃疡%出血%肺炎,医源性%H_2受体拮抗剂%质子泵抑制剂%荟萃分析
應激性潰瘍%齣血%肺炎,醫源性%H_2受體拮抗劑%質子泵抑製劑%薈萃分析
응격성궤양%출혈%폐염,의원성%H_2수체길항제%질자빙억제제%회췌분석
Stress ulcer%Bleeding%Pneumonia,nosocomial%Histamine-2 receptor antagonist%Proton pump inhibitor%Meta analysis
目的 评价质子泵抑制剂(PPI)及H_2受体拮抗剂(H_2RA)对预防重症患者应激性溃疡出血的有效性及安全性.方法 检索MEDLINE(1966年至2009年3月)、Ebsco、CNKI全文数据库,纳入PPI及H_2RA预防应激性溃疡出血的随机对照试验,由2名研究者独立对纳入试验进行质量评价和资料提取,通过病例选择、病例特征、随机方法、盲法、出血和肺炎的定义6个方面进行评分,讨论并采用RevMan 4.2.2软件进行Meta分析.结果 最终纳入4项临床试验,包括771例患者,Meta分析显示PPI组消化道大出血的发生率较H_2RA组低(2.2%比6.8%),差异有统计学意义[比值比(OR)0.45,95%可信区间(CI)0.21～0.96,P=0.04];PPI组与H_2RA组间医源性肺炎的发生率(10.0%比9.9%,OR 1.03,95%CI 0.63～1.70,P=0.89)及重症监护病房(ICU)病死率(14.5%比14.3%,OR 1.17,95%CI 0.76～1.80,P=0.47)差异无统计学意义.结论 通过现有资料的Meta分析提示PPI较H_2RA对应激性溃疡出血有更好的预防作用,两组间医源性肺炎的发生率及ICU病死率无显著差异.但鉴于目前关于PPI和H_2RA对预防应激性溃疡出血的随机对照研究较少,本次Meta分析总的样本量偏少,并且发表偏倚难以避免,上述分析结果应谨慎对待,有关结论尚需大样本、多中心的随机对照研究证实.
目的 評價質子泵抑製劑(PPI)及H_2受體拮抗劑(H_2RA)對預防重癥患者應激性潰瘍齣血的有效性及安全性.方法 檢索MEDLINE(1966年至2009年3月)、Ebsco、CNKI全文數據庫,納入PPI及H_2RA預防應激性潰瘍齣血的隨機對照試驗,由2名研究者獨立對納入試驗進行質量評價和資料提取,通過病例選擇、病例特徵、隨機方法、盲法、齣血和肺炎的定義6箇方麵進行評分,討論併採用RevMan 4.2.2軟件進行Meta分析.結果 最終納入4項臨床試驗,包括771例患者,Meta分析顯示PPI組消化道大齣血的髮生率較H_2RA組低(2.2%比6.8%),差異有統計學意義[比值比(OR)0.45,95%可信區間(CI)0.21～0.96,P=0.04];PPI組與H_2RA組間醫源性肺炎的髮生率(10.0%比9.9%,OR 1.03,95%CI 0.63～1.70,P=0.89)及重癥鑑護病房(ICU)病死率(14.5%比14.3%,OR 1.17,95%CI 0.76～1.80,P=0.47)差異無統計學意義.結論 通過現有資料的Meta分析提示PPI較H_2RA對應激性潰瘍齣血有更好的預防作用,兩組間醫源性肺炎的髮生率及ICU病死率無顯著差異.但鑒于目前關于PPI和H_2RA對預防應激性潰瘍齣血的隨機對照研究較少,本次Meta分析總的樣本量偏少,併且髮錶偏倚難以避免,上述分析結果應謹慎對待,有關結論尚需大樣本、多中心的隨機對照研究證實.
목적 평개질자빙억제제(PPI)급H_2수체길항제(H_2RA)대예방중증환자응격성궤양출혈적유효성급안전성.방법 검색MEDLINE(1966년지2009년3월)、Ebsco、CNKI전문수거고,납입PPI급H_2RA예방응격성궤양출혈적수궤대조시험,유2명연구자독립대납입시험진행질량평개화자료제취,통과병례선택、병례특정、수궤방법、맹법、출혈화폐염적정의6개방면진행평분,토론병채용RevMan 4.2.2연건진행Meta분석.결과 최종납입4항림상시험,포괄771례환자,Meta분석현시PPI조소화도대출혈적발생솔교H_2RA조저(2.2%비6.8%),차이유통계학의의[비치비(OR)0.45,95%가신구간(CI)0.21～0.96,P=0.04];PPI조여H_2RA조간의원성폐염적발생솔(10.0%비9.9%,OR 1.03,95%CI 0.63～1.70,P=0.89)급중증감호병방(ICU)병사솔(14.5%비14.3%,OR 1.17,95%CI 0.76～1.80,P=0.47)차이무통계학의의.결론 통과현유자료적Meta분석제시PPI교H_2RA대응격성궤양출혈유경호적예방작용,량조간의원성폐염적발생솔급ICU병사솔무현저차이.단감우목전관우PPI화H_2RA대예방응격성궤양출혈적수궤대조연구교소,본차Meta분석총적양본량편소,병차발표편의난이피면,상술분석결과응근신대대,유관결론상수대양본、다중심적수궤대조연구증실.
Objective To assess the efficacy and safety of proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H_2RA) in intensive care unit patients for stress ulcer prophylaxis. Methods A systematic search of MEDLINE (1966 to March 2009), Ebsco and CNKI was made. Two reviewers were assigned to assess the quality of studies and extracted data independently. Six items were evaluated for each trial (patient selection, patient characteristics, randomization, blinding, definition of bleeding and of pneumonia). Disagreements were resolved through discussion. RevMan 4.2.2 software developed by the eochrane collaboration was used for Meta-analysis. Results Four series of clinical use involving 771 patients were included. Meta-anatysis showed that the incidence of clinically significant bleeding was significantly lower in the PPI group (2.2% vs. 6.8%) as compared to H_2RA group [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.21 to 0.96, P=0.04]. There was no significant difference of the incidence of nosocomial pneumonia (10.0% vs. 9.9%, OR 1.03, 95%CI 0.63 to 1.70, P=0.89) and mortality (14.5% vs. 14.3%, OR 1.17, 95%CI 0.76 to 1.80, P=0.47) between two groups. Conclusion In comparison with H_2RA, PPI is more effective in the prevention of stress ulcer bleeding (SUB) in patients under intensive care. There is no significant difference in the incidence of nosocomial pneumonia and mortality between two groups. There were very few randomized controlled clinical trials on prevention of stress ulcer, and these findings were based on a small number of patients, therefore a steadfast conclusion cannot presently be reached. More randomized, muhicenter studies with sufficient sample size are warranted.
