质子抑制剂可以预防胃肠道出血 - - 一个更新的元分析
Ying Wang1, Sameer Parpia2, Long Ge3
1Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
NEJM evidence
|June 14, 2024
概括
质子抑制剂有效地预防严重病患者的上部胃肠道出血. 然而,它们对死亡率的影响是不确定的,并且可能因疾病严重程度而异,因此需要仔细考虑.
科学领域:
- 临界护理医学 临界护理医学
- 胃肠病学 胃肠病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 压力的预防对重症患者至关重要.
- 质子抑制剂 (PPI) 通常用于此目的.
- 在这个人群中,关于PPI有效性和安全性的证据需要综合.
研究的目的:
- 系统地审查PPI在压力预防中的有效性和安全性.
- 评估PPI对严重病情的成年人出血,死亡率和感染的影响.
- 根据疾病严重程度,探索PPI对死亡率的潜在差异性影响.
主要方法:
- 随机对照试验的系统审查和元分析.
- 包括12项试验,包括9533名严重病情严重的成年患者.
- 使用GRADE评估证据的确定性和子组分析的可信性.
主要成果:
- PPI显著减少了临床上重要的上部胃肠道出血 (高确定性).
- PPI对整体死亡率几乎没有影响 (确定性低).
- 亚组分析表明,PPI可能会降低不太严重的患者的死亡率,但会增加更严重的患者的死亡率.
结论:
- 高确定性证据支持PPI减少上部胃肠道出血.
- PPI对死亡率的影响是不确定的,可能取决于严重程度.
- 进一步的研究可能会澄清PPI在特定患者子组中的作用.
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