使用质子抑制剂与基因素-2受体阻断剂预防压力对接受侵入性机械通风的ICU患者住院死亡率的影响:PEPTIC随机临床试验
, Paul J Young1,2, Sean M Bagshaw3
1Medical Research Institute of New Zealand, Wellington.
JAMA
|January 18, 2020
概括
质子抑制剂 (PPI) 和组胺-2-受体抑制剂 (H2RBs) 在ICU的压力预防中显示出相似的住院死亡率. 在使用PPI时,胃肠上部出血的频率较低,但该研究存在局限性.
科学领域:
- 危急护理医学
- 药理学
- 胃肠病学
背景情况:
- 在重症监护室 (ICU) 的压力预防通常涉及质子抑制剂 (PPI) 或组胺-2受体抑制剂 (H2RB).
- 在ICU环境中,PPI与H2RB对患者死亡率的比较影响尚不清楚.
研究的目的:
- 为了比较接受PPI和接受H2RB用于压力预防的患者的住院死亡率.
- 评估二次结果,包括上部胃肠道出血,困难菌感染和停留时间.
主要方法:
- 在5个国家的50个重症监护室进行了集群交叉随机临床试验.
- 需要机械呼吸的患者被分配到PPI优先或H2RB优先的预防策略中.
- 首要结论是90天内住院死亡,共分析了26828名患者.
主要成果:
- 在PPI组的90日死亡率为18. 3%,在H2RB组为17. 5% (风险比:1. 05;95% CI,1. 00至1. 10).
- 在PPI组中发生的临床重要上部胃肠道出血为1. 3%,而在H2RB组中为1. 8% (风险比:0. 73;95% CI,0. 57至0. 92).
- 在Clostridioides difficile感染率或ICU/住院时间方面没有发现显著差异.
结论:
- 在接受机械呼吸治疗的ICU患者中,PPI和H2RB的死亡率与压力预防的住院死亡率相似.
- 与H2RB相比,PPI的临床重要胃肠道出血发生率较低.
- 由于治疗组之间的药物交叉,死亡率的解释可能受到限制.
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