NASIDs相关胃肠道损伤的PPI应用.ppt

* * * As we reviewed earlier, low-dose ASA even by itself can be problematic in high-risk patents. 正如我们以前所说，对于高危患者来说小剂量的ASA本身就是一个问题。 Lai and colleagues in 2002 reported a study of a group of patients hospitalized because of complicated ulcer disease (mainly bleeding) and who had been taking aspirin at a dose of only 100 mg per day. All patients were H. pylori positive. The ulcers were healed by treating the H. pylori infection. After ulcer healing and treatment of H. pylori infection, aspirin therapy was re-initiated and patients were also randomized to a PPI, lansoprazole 30 mg daily, or to placebo. Recurrent ulcer bleeding was extremely rare in those patients given lansoprazole with aspirin, while it occurred in almost 15% of those receiving aspirin. Lai及其同事，在2002年报道了一项临床研究。受试者因溃疡并发症（主要是出血）而住院，这些受试者每日服用阿司匹林的剂量仅为100mg/d。所有患者都存在HP感染。这些患者都进行了HP根除治疗和溃疡治疗。之后，患者重新开始使用阿司匹林，并随机分为PPI组（兰索拉唑30mg/d）和安慰剂组。研究结果显示：同时使用兰索拉唑和阿司匹林患者的溃疡再出血率非常之低，但安慰剂组的这一比例却接近15%。 * * * * * * * * According to the consensus document: If a patient needs antiplatelet therapy, the clinician should assess the patient’s GI risk factors. If the patient has a history of ulcer complication or of nonbleeding ulcer disease, evaluate whether H pylori infection is present and treat if indicated, before starting chronic antiplatelet therapy. Proton pump inhibitors should be prescribed if the patient has GI bleeding, is receiving dual antiplatelet therapy, or is receiving a concomitant anticoagulant. If none of these risk factors are present, the patient should still receive a proton pump inhibitor if more than one of the following apply: The patient is age 60 or older The patient uses corticosteroids The patient has dyspepsia or symptoms of gastroesophageal reflux disease 根据共识： 对于需要抗血小板治疗的患者，医生应评估其的消化系统风险。 对于曾有溃疡并发症或非出血性溃疡病的患者，应在开始慢性抗血小板治疗前，检查其是否存在HP感染，如感染则应先行HP根除术。 存在消化道出血的患者，如正在接受双重抗血小板治疗或同时使用抗凝剂，则应使用质子泵抑制剂。 即使不存在这些危险因素，但如果存在以下情况则仍需要继续使用PPI： 患者年龄超过60岁（含60岁） 患者使用皮质醇 患者存在消化不良或GERD症状 Bhatt DL, Scheiman