危重患者抑酸治疗与医院内获得性肺炎关系的荟萃分析  

Relationship between antacid therapy and hospital acquired pneumonia in critically ill patients： a meta- analysis

作　　者：单亮[1] 李秀[2] 刘克[1] 孙美娜[1] 姚志欣[1] 李连弟[1] 

机构地区：[1]青岛大学医学院附属医院脑科重症医学科,山东266003 [2]青岛大学医学院附属医院门诊部,山东266003

出　　处：《中华危重病急救医学》2013年第6期360-364,共5页Chinese Critical Care Medicine

基　　金：山东省自然科学基金项目（Y2008C25）

摘　　要：目的系统评价重症监护病房（ICU）危重患者使用抑酸剂对胃黏膜病变出血的治疗效果，以及与医院内获得性肺炎（HAP）、住院病死率的关系。方法通过检索1980年1月至2012年12月美国国家图书馆PubMed数据库，收集ICU危重患者应用抑酸剂与硫糖铝疗效比较的随机对照临床研究（RCT）文献，并进行荟萃分析（meta分析）。结果共有12项RCT研究包括2537例ICU患者入选。与硫糖铝相比，抑酸剂能明显增加HAP的发病率[19．36％（249／1286）比15．23％（184／1208），优势比（OR）=1．27，95％可信区间（95％CI）为1．03～1．57，P=0．02]。对上消化道出血的亚组分析表明，抑酸剂较硫糖铝可明显减少临床大出血的发病率[1．80％（12／667）比3．86％（26／673），OR=0．46，95％CI为0．23～0．91，P=0．03]，但并不影响显性出血的发病率[7．09％（40／564）比7．35％（36／490），OR=1．00，95％CI为0．62～1．62，P=0．99]。不管是抑酸剂还是硫糖铝，对ICU病死率和住院病死率均无影响[25．58％（288／1126）比23．65％（268／1133），OR=1．11，95％CI为0．92～1．35，P=0．28]。结论与硫糖铝比较，使用抑酸剂治疗ICU危重患者，在有效减少上消化道大出血的同时，可以明显增加HAP发病率，但对病死率无影响；应该限制此类药物在ICU的过度应用，并对其应用及停药指征进行相关研究。Objective To systematically review the effect of antacid medication on stress-related mucosal disease （ SRMD ） bleeding, hospital acquired pneumonia （ HAP ）, and hospital mortality in critically ill patients admitted to intensive care unit （ICU）. Methods Related articles were retrieved fi＇om Medline Database （from January 1980 to December 2012）. Randomized control trials （RCTs） focused on comparison between antacid and sucralfate were collected, and then a meta-analysis was performed. Results Twelve studies including a total of 2537 patients admitted to ICU were qualified for analysis. Antacid medication significantly increased the incidence of HAP when compared with sucralfate in 11 trials [ 19.36% （ 249/1286 ） vs. 15.23% （ 184/1208 ）, odds ratio （ OR ） = 1.27, 95% confidence interval （95%CI）： 1.03-1.57, P=0.02t. Subgroup analyses showed that antacid therapy significantly reduce the incidence of clinically significant bleeding compared with sucralfate [ 1.80% （ 12/667 ） vs. 3.86% （26/673）, OR=0.46, 95%（;1： 0.23-0.91, P= 0.031, however, it did not lower the incidence of overt bleeding [ 7.09% （40/564） vs. 7.35% （36/490）, OR ： 1.00, 95% CI： 0.62-1.62, P=0.991. There was no significant difference between antacid group and sucralfate group on neither ICU mortality nor hospitalization mortality in 11 studies [ 25.58% （ 288/1126 ） vs. 23.65% （ 268/1133 ）, OR=1.11, 95%CI： 0.92-1.35, P=0.281. Conclusions Antacid therapy used in critically ill patients may increase the incidence of HAP while reduce the rate of upper gastrointestinal bleeding, while it exerts no influence on mortality rate when compared with sucralfate treatment in this meta-analysis. It is imperative to restrict the overuse of sueh medication, and further RCTs focused on indication and withdrawal should be encouraged.

关 键 词：抑酸剂 医院内获得性肺炎 上消化道出血 应激性黏膜病变 病死率 硫糖铝 

分 类 号：R563[医药卫生—呼吸系统] R45[医药卫生—内科学]