• 1. 四川大學(xué)華西醫(yī)院急診科, 成都 610041　2. 成都市第三人民醫(yī)院消化內(nèi)科, 成都 610041;

目的　 系統(tǒng)評(píng)價(jià)質(zhì)子泵抑制劑(PPI)與H2受體阻滯劑(H2RA)預(yù)防腦卒中后應(yīng)激性潰瘍出血的臨床療效及安全性.
方法 　計(jì)算機(jī)檢索Cochrane圖書館(2005年第4期)、MEDLINE(1966～2005年10月)、EMBASE(1984～2005年10月)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(1980～2005年10月)和中文科技期刊全文數(shù)據(jù)庫(kù)(1980～2005年10月),并手工檢索已發(fā)表和未發(fā)表試驗(yàn).納入PPI、H2RA預(yù)防腦卒中后SUB的隨機(jī)對(duì)照試驗(yàn).由兩名評(píng)價(jià)員獨(dú)立選擇試驗(yàn)和提取資料,并對(duì)其方法學(xué)質(zhì)量進(jìn)行評(píng)價(jià).對(duì)符合納入標(biāo)準(zhǔn)的研究采用RevMan4.2.7軟件進(jìn)行Meta分析.
結(jié)果 　共納入20個(gè)隨機(jī)對(duì)照試驗(yàn)(2 624例).Meta分析結(jié)果顯示:①應(yīng)激性潰瘍出血(SUB)的發(fā)生率: PPI能降低腦卒中后SUB的發(fā)生率[OR 0.14,95%CI (0.08, 0.24),NNT=3];H2RA能降低腦卒中后SUB的發(fā)生率[OR 0.24,95%CI (0.15,0.39),NNT=5];與 H2RA相比,PPI降低腦卒中患者SUB的發(fā)生率的效果優(yōu)于H2RA(P lt;0.000 01).②病死率:預(yù)防性使用PPI可降低腦卒中患者的病死率[OR 0.22,95%CI(0.11,0.47),NNT=8];預(yù)防性使用H2RA能降低腦卒中患者的病死率[OR 0.53,95%CI(0.34, 0.81),NNT＝16];與H2RA相比,預(yù)防性使用PPI降低腦卒中患者病死率的效果優(yōu)于H2RA[OR 0.28,95%CI(0.09,0.89)].③藥物不良反應(yīng)發(fā)生率:PPI組及H2RA組均未見明顯不良反應(yīng)發(fā)生.
結(jié)論 　現(xiàn)有的有限證據(jù)表明, 預(yù)防性使用PPI和H2RA均能降低腦卒中后SUB的發(fā)生率、病死率,其中PPI降低SUB發(fā)生率的效果明顯優(yōu)于H2RA.

引用本文： 王一平,曾 超,吳宗英. 質(zhì)子泵抑制劑和H2受體阻滯劑類藥物預(yù)防腦卒中后應(yīng)激性潰瘍出血的系統(tǒng)評(píng)價(jià). 中國(guó)循證醫(yī)學(xué)雜志, 2006, 06(2): 107-116. doi: 復(fù)制

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3. Lou JJ,Yan CJ,Chen H.Effect of cold constraint stress against microcirculation in big mouse.Microcircuology,1996 ; 6(4):8-10.樓繼軍,宴才杰,陳華.冷束縛應(yīng)激對(duì)大鼠胃微循環(huán)的影響.微循環(huán)學(xué),1996 ; 6(4):8～10.
4. Yasue N,Guth PH.Role of exogenous acid and retransfusion in hemorrhagic shock-induced gastric lesions in he rat.Chinese Journal of Microcirculation,1988 ; 94 (5):1135-1143.
5. Murakami M.Pathophysiology and pathogenesis of acute gastric mucosa lesions after hypothermic restraint stress in rats.Gastroenterology,1985 ; 88 (3):660-665.
6. Kivilaakso E.Relationship between ulceration and intramural pH of gastric mucosa during hemorrhagic shock.Surgery,1987; 102:27.
7. Priebe HJ.Antacid versus cimetidine in preventing acute gastrointestina bleeding.N EngI J Med,1980; 302 (8):426-427.
8. Main points of dignosis of cerebrovascular disease.Chinese Journal of Neurology,1996; 29(6):379.各類腦血管疾病診斷要點(diǎn)(1995年中華醫(yī)學(xué)會(huì)全國(guó)第四屆腦血管病學(xué)術(shù)會(huì)議通過).中華神經(jīng)科雜志,1996;29(6):379.
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10. Liang J.Lansoprazole for stress ulcer bleeding in 30 patients of cerebral hemorrhage resulted of high pressure.New Medicine,1997;28(6):295-296.粱健.蘭索拉唑?qū)︻A(yù)防高血壓性腦出血后應(yīng)激性潰瘍30例的作用.新醫(yī)學(xué),1997;28(6):295～296.
11. Wei DS.Omeprazole and Cimetidine for acute cerebral vascular disease with stress ulcer bleeding.Journal of Modern Clinical Medical Bioengineering,2002;8(2):130-132.魏端生.洛賽克與西咪替丁預(yù)防急性腦血管病并應(yīng)激性潰瘍出血的臨床研究.Journal of Modern Clinical Medical Bioengineering,2002;8(2):130～132.
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  1. 1. Cheng XM.Epidemiology of Cerebrovascular Disease.4th edition.Beijing:Chinese Science and Technique Publishing Company,1993; 11-13.程學(xué)銘.腦血管病的流行病學(xué).第4版.北京:中國(guó)科學(xué)技術(shù)出版社,1993;11～13.
  2. 2. Peng NS.Prognosis of 1000 cute brain hemorrhage cases.Chinese Journal of Emergency,1996;16(5):32-33.彭南生.急性腦出血1000例預(yù)后研究.中國(guó)急救醫(yī)學(xué)雜志,1996;16(5):32～33.
  3. 3. Lou JJ,Yan CJ,Chen H.Effect of cold constraint stress against microcirculation in big mouse.Microcircuology,1996 ; 6(4):8-10.樓繼軍,宴才杰,陳華.冷束縛應(yīng)激對(duì)大鼠胃微循環(huán)的影響.微循環(huán)學(xué),1996 ; 6(4):8～10.
  4. 4. Yasue N,Guth PH.Role of exogenous acid and retransfusion in hemorrhagic shock-induced gastric lesions in he rat.Chinese Journal of Microcirculation,1988 ; 94 (5):1135-1143.
  5. 5. Murakami M.Pathophysiology and pathogenesis of acute gastric mucosa lesions after hypothermic restraint stress in rats.Gastroenterology,1985 ; 88 (3):660-665.
  6. 6. Kivilaakso E.Relationship between ulceration and intramural pH of gastric mucosa during hemorrhagic shock.Surgery,1987; 102:27.
  7. 7. Priebe HJ.Antacid versus cimetidine in preventing acute gastrointestina bleeding.N EngI J Med,1980; 302 (8):426-427.
  8. 8. Main points of dignosis of cerebrovascular disease.Chinese Journal of Neurology,1996; 29(6):379.各類腦血管疾病診斷要點(diǎn)(1995年中華醫(yī)學(xué)會(huì)全國(guó)第四屆腦血管病學(xué)術(shù)會(huì)議通過).中華神經(jīng)科雜志,1996;29(6):379.
  9. 9. Zhang FL,Zhao JH,Li Y.The clinical effective observation of Lansoprazole for stress ulcer bleeding in patients of cerebral stroke.Chinese Journal of Clinical Pharmacology and Therapeutics,2002;7(4):351-352.張鳳蘭,趙均和,李巖.蘭索拉唑預(yù)防急性腦卒中后應(yīng)激性潰瘍出血的臨床療效觀察.中國(guó)臨床藥理學(xué)與治療學(xué),2002;7(4):351～352.
  10. 10. Liang J.Lansoprazole for stress ulcer bleeding in 30 patients of cerebral hemorrhage resulted of high pressure.New Medicine,1997;28(6):295-296.粱健.蘭索拉唑?qū)︻A(yù)防高血壓性腦出血后應(yīng)激性潰瘍30例的作用.新醫(yī)學(xué),1997;28(6):295～296.
  11. 11. Wei DS.Omeprazole and Cimetidine for acute cerebral vascular disease with stress ulcer bleeding.Journal of Modern Clinical Medical Bioengineering,2002;8(2):130-132.魏端生.洛賽克與西咪替丁預(yù)防急性腦血管病并應(yīng)激性潰瘍出血的臨床研究.Journal of Modern Clinical Medical Bioengineering,2002;8(2):130～132.
  12. 12. Huaug YF.Omeprazole for acute cerebral hemorrhage with stress ulcer bleeding.Medical Theory and Practice,2004;17(10):1166-1167.黃永鋒.奧美拉唑預(yù)防急性腦出血并發(fā)應(yīng)激性潰瘍消化道出血的療效觀察.醫(yī)學(xué)理論與實(shí)踐,2004;17(10):1166～1167.
  13. 13. Liu K.Pantoprazole for cerebral hemorrhage resulted of high pressure with stress ulcer bleeding.Medical Theory and Practice,2004;17(10):1166-1167.劉坤.潘托拉唑?qū)︻A(yù)防高血壓性腦出血后應(yīng)激性潰瘍的作用.醫(yī)學(xué)理論與實(shí)踐,2004;17(2):161～162.
  14. 14. Wang QR,Pei GZ.Pantoprazole for stress ulcer in 43 severe cerebral hemorrhage patients.Chinese Society Physician,2003;5(8):21-22.王全讓,裴廣忠.泮妥拉唑鈉對(duì)重度腦出血并發(fā)應(yīng)激性潰瘍43例的預(yù)防作用.中國(guó)社區(qū)醫(yī)師,2003;5(8):21～22.
  15. 15. Shang XW.The effect of omeprazole preventing severe cerebral hemorrhage with stress gastric lesions.Journal of Henan Employee Medical University,2004;16(3):271-272.尚現(xiàn)偉.洛賽克在預(yù)防重癥腦出血并發(fā)應(yīng)激性胃粘膜病變中的作用.河南職工醫(yī)學(xué)院學(xué)報(bào),2004;16(3):271～272.
  16. 16. Gui JW.Cimetidine preventing cerebral hemorrhage with stress ulcer in old patients.Hengyang Journal of Medical University,1997;25(4):404-405.桂建偉.西咪替丁對(duì)老年人腦出血并發(fā)應(yīng)激性潰瘍的預(yù)防.衡陽醫(yī)學(xué)院學(xué)報(bào),1997;25(4):404～405.
  17. 17. Peng XL,Tang BS,Yang QD et al.Clinical observation of prevention of cerebral hemorrhage with stress ulcer.Chinese Journal of Modern Medicine,1997;7(2):67-68.彭曉蘭,唐北沙,楊期東等.腦出血應(yīng)激性潰瘍預(yù)防性治療的臨床觀察.中國(guó)現(xiàn)代醫(yī)學(xué)雜志,1997;7(2):67～68.
  18. 18. Xu ZQ.Effect of famotidine preventing cerebral stroke with stress ulcer bleeding.Chinese Journal of Clinical New Medicine,2002;2(12):1127-1128.許志強(qiáng).法莫替丁預(yù)防腦卒中應(yīng)激性潰瘍出血的療效觀察.中華臨床新醫(yī)學(xué),2002;2(12):1127～1128.
  19. 19. Huang YF,Huang AZ,Wei HL.Effect of famotidine preventing cerebral stroke with stress ulcer bleeding.Huaxia Medicine,2003;16(3):315-316.黃永鋒,黃愛珍,韋海玲.法莫替丁預(yù)防腦出血并發(fā)應(yīng)激性潰瘍出血的效果觀察.華夏醫(yī)學(xué),2003;16(3):315～316.
  20. 20. Lu YH.Cimetidine preventing for cerebral hemorrhage resulted of high pressure with stress ulcer.Chinese Emergency Disease Medicine,1998;10(7):446.陸億華.泰胃美注射液預(yù)防高血壓性腦出血后應(yīng)激性潰瘍.中國(guó)危重病急救醫(yī)學(xué),1998;10(7):446.
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