Review文献1997 A Review of Stress Ulcer Prophylaxis in the Neurosurgical Intensive Care Unit.pdfVIP

Neurosurgery Issue: Volume 41(2), August 1997, pp 416-426 Copyright: Copyright © by the Congress of Neurological Surgeons Publication Type: [Topic Review] ISSN: 0148-396X Accession:199708000-00017 Keywords: Critical care, Gastrointestinal bleeding, Neurosurgery, Stress ulcer [Topic Review] ◀ Previous Article | Table of Contents | Next Article ▶ A Review of Stress Ulcer Prophylaxis in the Neurosurgical Intensive Care Unit Lu, William Y. MD; Rhoney, Denise H. PharmD; Boling, Warren B. MD; Johnson, John D. MD; Smith, Terry C. MD Author Information Central Florida Neurosurgical Associates (WYL), Orlando, Florida; Department of Pharmacy (DHR), Detroit Receiving Hospital, Detroit, Michigan; Division of Neurosurgery (WBB, JDJ, TCS), University of Kentucky Medical Center, Lexington, Kentucky Received, August 20, 1996. Accepted, February 14, 1997. Reprint requests: William Y. Lu, M.D., Central Florida Neurosurgical Associates, 328 E. Spruce Street, Orlando, FL 32804. Back to Top Abstract STRESS ULCERS OCCUR frequently in intensive care unit patients who have intracranial disease. After major physiological stress, endoscopic evidence of mucosal lesions of the gastrointestinal tract appears within 24 hours of injury; 17% of these erosions progress to clinically significant bleeding. Gastrointestinal hemorrhage has been associated with mortality rates of up to 50%. The pathogenesis of stress ulcers may not be completely understood, but gastric acid and pepsin appear to play significant roles. Antacids, H antagonists, and sucralfate are effective prophylactic agents in the 2 medical/surgical intensive care unit. Appropriate therapy for neurosurgical patients remains unclear, however. This review summarizes the current literature regarding the pathogenesis and therapy of stress ulcers in neurosurgical patients. Stress ulcers occur frequently in intensive care unit (ICU) patients who have intracranial di