围术期应用质子泵抑制剂预防应激性溃疡的现状调查

摘要

目的 调查围术期使用质子泵抑制剂(PPI)预防应激性溃疡的情况,促进PPI的合理使用.方法 回顾性收集2016年9月首都医科大学附属北京安贞医院心外某科使用PPI预防应激性溃疡104例患者的临床资料,分析PPI使用的危险因素及指征、种类、合并用药、剂量、给药时机、疗程等.结果 104例患者中9例(8.7％)为无指征用药;37例(35.6％)患者只使用了1种PPI,50例(48.1％)患者先后使用了2种PPI,16例(15.4％)患者先后使用了3种PPI,另有1例(1.0％)患者先后使用了4种PPI;18例患者合并使用华法林,其中13例应用艾司奥美拉唑,7例应用兰索拉唑,2例应用泮托拉唑,2例应用奥美拉唑,2例应用雷贝拉唑;2次/d给药比例为38.2％ (68/178),其余均为1次/d给药;4例患者术前使用PPI,100例患者术后使用PPI;使用PPI的疗程为1～16 d;48.1％ (50/104)的患者在危险因素消失后仍使用PPI;使用PPI后仍发生出血患者2例(1.9％),发生肺炎患者9例(8.7％),未发生艰难梭菌感染.结论 我院心外某科围术期使用PPI预防应激性溃疡存在单人用药品种过多、疗程过长等不合理情况,应加强监管,防止过度使用.%Objective To investigate the use of proton pump inhibitors(PPI) in prevention of stress ulcer during perioperative period and to promote the rational use of PPI.Methods Clinical data of 104 cardiac surgery patients who were treated with PPI for prevention of stress ulcer in September 2016 at Beijing Anzhen Hospital,Capital Medical University were retrospectively cdlected.Risk factors and indications,types and doses,medication timing and course of PPI were analyzed.Results Nine patients(8.7％) had no PPI indication.Thirty-seven patients(35.6％) used 1 kind of PPI;50 patients(48.1％) used 2 kinds of PPI;16 patients(15.4％) used 3 kinds of PPI;1 patients(1.0％) used 4 kinds of PPI.Eighteen patients were treated with PPI plus warfarin;13 of them used esomeprazole;7 patients used lansoprazole;2 patients used pantoprazole;2 patients used omeprazole;2 patients used rabeprazole;38.2％ (68/178) of patients took PPI 2 times/d and others took PPI 1 time/d.Four patients had PPI before operation;100 patients had PPI after operation.Medication course of PPI was 1-16 d;48.1％ (50/104) of patients still used PPI after risk factors disappeared.Two patients (1.9％) had bleeding events.Nine patients(8.7％) had pneumonia.No Clostridium difficile infection occurred.Conclusion There are irrational uses of PPI in cardiac surgery department such as excessive types and long medication duration.