Daily Usage of Proton Pump Inhibitors May Reduce the Severity of Critical Upper Gastrointestinal Bleeding in Elderly Patients
Daily Usage of Proton Pump Inhibitors May Reduce the Severity of Critical Upper Gastrointestinal Bleeding in Elderly Patients
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每日使用质子泵抑制剂可减轻老年患者危重上消化道出血的严重程度
DOI：
10.1155/2020/7168621
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发表时间：
2020
影响因子：
2
通讯作者：
Nakamoto Yasunari
中科院分区：
文献类型：
--
作者：
Matsuda Hidetaka;Nosaka Takuto;Akazawa Yu;Saito Yasushi;Ozaki Yoshihiko;Takahashi Kazuto;Naito Tatsushi;Ofuji Kazuya;Ohtani Masahiro;Hiramatsu Katsushi;Nakamoto Yasunari
介绍。我们回顾性研究了每日质子泵抑制剂（PPI）的使用与上消化道出血（UGIB）严重程度之间的关系，主要是在老年人中。方法。我们纳入了2012年1月至2017年10月在我院诊断的97例非静脉曲张性上消化道出血患者。使用休克指数（SI）和估计出血量评估出血严重程度； 49名患者符合轻度组标准，48名患者符合中重度组标准。比较各组之间 PPI 使用对出血严重程度的影响。分析PPI使用及剂量与UGIB临床症状的关系。结果。 97 例患者中，17 例（17.5%）习惯性使用 PPI。轻度组习惯性使用 PPI 的比例显着较高，在多重 Logistic 回归分析中表明这是导致 UGIB 严重程度降低的独立因素（30.6% vs. 4.2%；OR 10.147；95% CI 2.174–47.358，P< 0.01）。在分析75岁以上患者亚组的数据时，我们发现轻度UGIB组的PPI保护作用甚至高于中/重度组（37.0% vs. 5.6%；OR 10.000；95% CI 1.150–86.951，P< 0.05）。相反，我们发现 75 岁以下患者的 PPI 处方与 UGIB 症状之间没有关联。 17名习惯性PPI使用者的平均估计出血量和SI均显着低于80名非习惯性使用者（P<0.05）。低剂量和高剂量 PPI 使用者之间轻度 UGIB 患者的比例相似。结论。特别是对于患有非静脉曲张性 UGIB 的老年患者，无论 PPI 的适应剂量如何，习惯性使用 PPI 都可以通过抑制出血量来缓解 UGIB 的临床症状。
Introduction. We retrospectively examined the relationship between daily proton pump inhibitor (PPI) use and severity of upper gastrointestinal bleeding (UGIB), mainly in the elderly.Methods. We included 97 patients with nonvariceal UGIB diagnosed at our hospital from January 2012 to October 2017. Bleeding severity was assessed using the shock index (SI) and estimated bleeding volume; 49 patients met the criterion for the mild group and 48 for the moderate/severe group. The effect of PPI use on bleeding severity was compared between the groups. The relationships of PPI use and dose with the clinical symptoms of UGIB were also analyzed.Results. Among the 97 patients, 17 (17.5%) habitually used PPIs. The rate of habitual PPI use was significantly higher in the mild group, indicating as an independent factor contributing to a reduction in the severity of UGIB in a multiple logistic regression analysis (30.6% vs. 4.2%; OR 10.147; 95% CI 2.174–47.358,P< 0.01). When analyzing data for a subgroup of patients older than 75 years, we found the protective PPI effect to be even higher in the mild UGIB group than in the moderate/severe group (37.0% vs. 5.6%; OR 10.000; 95% CI 1.150–86.951,P< 0.05). Conversely, we found no association between PPI prescription and UGIB symptoms in patients younger than 75 years. The mean estimated bleeding volume and SI in the 17 habitual PPI users were both significantly less than those among the 80 nonhabitual users, respectively (P< 0.05). The proportion of patients with mild UGIB was similar between the low‐ and high‐dose PPI users.Conclusions. Particularly in elderly patients with nonvariceal UGIB, habitual PPI use can alleviate the clinical symptoms of UGIB by suppressing the volume of bleeding, regardless of the adapted dose of PPIs.