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目的了解神经科住院急性脑卒中患者抑酸药预防性应用情况,进行循证医学评价,为临床合理应用抑酸药提供依据。方法收集某三甲教学医院神经科一病房2009年8月1日至12月1日期间预防性应用抑酸药的急性脑卒中住院患者的信息,应用我国制定的应激性溃疡防治建议对抑酸药的应用进行评价。系统检索美国全科医学文献数据库(MEDLINE)、荷兰医学文献(EMBASE)、中国生物医学文献光盘数据库(CBM)、中文科技期刊全文数据库(CNKI)和科克伦图书馆(Cochrane Li-brary),收集有关抑酸药用于预防卒中后应激性溃疡的循证医学证据,以此评价抑酸药的应用。结果调查期间该病房有急性脑卒中住院患者178例,其中53例(29.7%)预防性应用抑酸药。按照我国制定的应激性溃疡防治建议,预防性应用抑酸药的病例中,有32例(60.4%)符合预防性应用抑酸药的指证。按照所获得的循证医学证据,有证据的抑酸药预防性应用占75.5%,包括:急性脑卒中病情较重,或既往有消化道溃疡史、现应用阿司匹林,或双重抗血小板聚集药,或抗凝剂与抗血小板聚集药联用,或应用非甾体抗炎药。而以下情况元预防性应用抑酸药的循证医学证据:应用抗凝剂,或既往有消化道溃疡史但本次发病后未用抗血小板聚集药者,或发病时有恶心、呕吐症状。结论多数急性脑卒中预防性应用抑酸药病例符合现有循证医学证据。对于少数不符合循证医学证据的病例,其抑酸药预防性应用是否必要,还需进一步研究和评价。
Abstract：AIM To investigate the using of acid-suppressive agents in patients suffering from acute stroke in a large teaching hospital and to provide evidence-based medicine for rational using of acid-suppressive drugs.METHODS Information related to the using of acid-suppressive drugs after acute stroke was collected in the hospital from Aug 1st, 2009 to Sep 1st,2009.The using of acid-suppressive drugs was evaluated according to the suggestion of preventing stress ulcer in China.Relevant databases were searched,including MEDLINE,EMBASE,CBM,CNKI and Cochrane Library, to find evidence which provided surpport for the prophylactic application of acid-suppressive drugs in stroke.RESULTS Totally 178 acute stroke patients were admitted in the neurological ward during the observation period.Among them,53 patients(29.7%) were prescribed acid-suppressive drugs to prevent stress ulcer.According to the suggestion of preventing stress ulcer in China,32 patients(60.4%) had evidence to use acid-suppressive drugs.According to the evidence collected from the electronic database,75.5%patients had evidence in prophylactic application of acid-suppressive drugs,including serious acute stroke,or using aspirin and having history of peptic ulcer,or using non-steroidal anti- inflammatory drugs(NSAID).Meanwhile,conditions lacking evidence included using anticoagulants,or having histoiy of peptic ulcer but not using antiplatelet agents,or with nausea or vomiting.CONCLUSION Most of the patients with acute stroke have evidence-based medicine to support the prophylactic application of acid-suppressive drugs.However, some patients are lack of evidence-based medicine.Further researches should be carried out to provide evidence for the prophylactic application of acid-suppressive drugs.
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基本信息:
DOI：10.19577/j.cnki.issn10074406.2011.05.008
中图分类号:R743.3
引用信息:
[1]隗茂芸,刘芳.急性脑卒中后抑酸药预防性应用情况调查和循证医学评价[J].中国临床药学杂志,2011,20(05):286-290.DOI:10.19577/j.cnki.issn10074406.2011.05.008.
2011-09-25
2011-09-25