质子抑制剂是否有效防止食道内镜下粘膜切割后的术后出血?
Ippei Tanaka1,2, Kunio Tarasawa3, Hiroaki Saito1,4
1Department of Gastroenterology, Sendai Kousei Hospital, Sendai, Japan.
概括
质子抑制剂 (PPI) 和vonoprazan在食道内镜下粘膜解剖 (ESD) 后没有防止延迟出血. 这项研究表明,这些抑制酸的药物可能不推用于预防术后出血.
科学领域:
- 胃肠病学 胃肠病学
- 内镜检查是指内镜检查.
- 药理学 药理学是指药理学的学科.
背景情况:
- 延迟出血是食道内镜下粘膜解剖 (ESD) 的已知并发症.
- 质子抑制剂 (PPI) 用于防止胃ESD后出血,但它们在食道ESD中的有效性尚不清楚.
- 诺普拉桑是另一种抑制酸的药物,可能有助于预防.
研究的目的:
- 评估质子抑制剂 (PPI) 或诺普拉桑在食道内学下粘膜解剖 (ESD) 后预防延迟出血的有效性.
主要方法:
- 使用日本诊断程序组合 (DPC) 数据库进行的回顾性队列研究.
- 包括在2012年1月至2020年12月期间接受食道ESD的患者.
- 倾向性得分匹配分析将接受PPI或vonoprazan的患者与未接受PPI或vonoprazan的患者进行比较,评估延迟出血率.
主要成果:
- 总共有54,345名患者被分析,其中1126名 (2.07%) 经历了延迟出血.
- 在倾向分数匹配 (8237对) 后,在酸抑制组 (PPI或vonoprazan) 和没有酸抑制组 (OR:1.20,95% CI:0.93-1.54,P=0.227) 之间没有观察到延迟出血率的显著差异.
- 对PPI/vonoprazan剂量,瘤位置和同时使用抗血栓剂/抗凝剂的分分析没有显示出显著的预防作用.
结论:
- 质子抑制剂 (PPI) 和vonoprazan的使用没有显著地防止食道ESD后延迟出血.
- 目前的证据不支持PPI或诺普拉赞的常规处方,以预防食道后ESD延迟出血.
- 可能需要进一步的研究来探索在食道ESD中预防出血的替代策略.
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