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目的:探讨慢性阻塞性肺疾病急性发作期(AECOPD)患者应用糖皮质激素(GCs)后预防使用质子泵抑制剂(PPIs)的必要性、有效性及安全性。方法:收集2013年8月-2015年8月在华中科技大学同济医学院附属普爱医院诊断为AECOPD、住院期间应用了GCs的患者,统计其GCs和PPIs的使用情况、应激性溃疡或胃肠道出血风险高危因素和药品不良反应(ADR)发生情况。结果:共纳入了666例GCs治疗患者,其中660例使用注射用甲泼尼龙琥珀酸钠,614例(92.19%)使用剂量为30~40 mg/d,GCs平均使用疗程为(5.70±2.97)d。联合使用PPIs的患者663例(99.55%),PPIs平均使用疗程为(8.60±4.55)d,其中472例(70.76%)使用注射用泮托拉唑(剂量40~160 mg)。663例使用PPIs的患者中,有403例(60.78%)存在1个及以上应激性溃疡或胃肠道出血风险高危因素,其中有12例患者发生了ADR,包括应激性溃疡6例、大便潜血阳性3例、胃部不适2例和消化道大出血1例;3例未联合使用PPIs的患者中,1例存在应激性溃疡或胃肠道出血风险高危因素,均未发生ADR。结论:临床上对于应用了GCs的患者,应进行应激性溃疡或胃肠道出血高危因素风险评估,再考虑是否使用PPIs,避免此类药物的滥用。
OBJECTIVE: To investigate the necessity, effectiveness and safety of prophylactic application of proton pump inhibitors (PPIs) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) after glucocorticoids (GCs) use. METHODS: The patients diagnosed as AECOPD receiving GCs during hospitalization were collected from Pu’ai Hospital of Tongji Medical College, Huazhong University of Science and Technology during Aug. 2013-Aug. 2015. The application of GCs and PPIs, risk factor of stress ulcer or gastrointestinal bleeding, the occurrence of ADR were analyzed statistically. RESUITS: A total of 666 patients using GCs were included, among which 660 patients were given Methylprednisolone for injection. The dose of GCs of 614 cases (92.19%) were 30-40 mg/d, and average treatment course of GCs was (5.70±2.97) d. Combined use of PPIs occurred in 663 cases (99.55%) and average duration of PPIs was (8.60±4.55)d, among which 472 cases (70.76%) received Pantoprazole for injection (40-160 mg). Among 663 patients receiving PPIs, more than one risk factor of stress ulcer or gastrointestinal bleeding were found in 403 cases (60.78%), and 12 of them suffered from ADR including 6 cases of stress ulcer, 3 cases of positive dccult blood, 2 cases of stomach discomfort and 1 case of gastrointestinal massive bleeding. Among 3 patients without using PPIs, risk factor of stress ulcer or gastrointestinal bleeding was found in one case, but ADR was not found. CONCLUSIONS: For those patients receiving GCs, PPIs selection should be based on risk factor evaluation of stress ulcer or gastrointestinal bleeding, to avoid abuse of this type.
慢性阻塞性肺疾病急性发作期糖皮质激素质子泵抑制剂应激性溃疡胃肠道出血
Acute exacerbation of chronic obstructive pulmonary diseaseGlucocorticoidsproton pump inhibitorStress ulcerGastrointestinal bleeding
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