関連する実験動画
重症患者のストレス潰瘍予防. 矛盾するメタ解析の解決
D J Cook1, B K Reeve, G H Guyatt
1Department of Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada.
JAMA
|January 24, 1996
まとめ
ヒスタミン2受容体アンタゴニストは,重症患者の胃腸出血を大幅に軽減します. サクラルファートは,肺炎と死亡率の低下において有望であることが示され,ストレス潰瘍予防のための潜在的な代替案を提供している.
科学分野:
- クリティカルケア・メディシン
- 薬理学 薬理学とは
- 根拠に基づいた医学は,証拠に基づいた医療です.
背景:
- ストレス潰瘍の予防は,重症患者にとって極めて重要です.
- 以前の体系的なレビューでは,有効性と安全性に関する不一致があった.
- 最適な予防薬の特定は,患者のアウトカムにとって不可欠です.
研究 の 目的:
- 以前のシステマティック・オーバービューの不一致を解決する.
- 胃腸出血,肺炎,死亡率に対するストレス潰瘍予防の効果を推定する.
- ヒスタミン2受容体アンタゴニスト,抗酸剤,およびスクラルファートの有効性を比較する.
主な方法:
- 公開された研究と未公開の研究の包括的な検索.
- 269件の論文をレビューした結果,63件の関連するランダム化対照試験を取り入れた.
- 研究の質,集団,介入,結果の独立した評価.
主要な成果:
- ヒスタミン2受容体アンタゴニストは,明らかな,臨床的に重要な胃腸出血を著しく減少させた.
- サクラルファートは,他の薬剤と比較して肺炎の発生率を下げ,死亡率を下げる傾向を示した.
- 以前のレビューの不一致は,研究の選択,定義,統計的方法から生じた.
結論:
- ヒスタミン2受容体アンタゴニストは,臨床的に重要な胃腸出血を減らすための強力な証拠を提供します.
- サクラルファートは,出血に対して胃のpHを変化させる薬と同じくらい効果的であり,肺炎と死亡率において有益である.
- 改善された試験登録簿と体系的なレビュー方法論が必要である.
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