姬晓艳，朱文霞，谢　陵



质子泵抑制剂不同给药方式对消化道溃疡出血病人预后影响的Meta分析

姬晓艳，朱文霞，谢陵

摘要：[目的]系统评价质子泵抑制剂不同给药方式对消化道溃疡出血病人预后的影响，以期为消化道溃疡出血病人质子泵抑制剂给药方式的选择提供证据。[方法]计算机检索PubMed、EMbase、The Cochrane Library、中国知网(CNKI)、万方数据库(WanFang Data)、中国生物医学文献数据库(CBM)，检索时限定为建库至2015年3月，收集有关质子泵抑制剂不同给药方式对消化道溃疡所致出血病人治疗效果的随机对照试验(RCT)。采用RevMan 5.3软件进行Meta分析。[结果]最终纳入7项RCT，共计927例病人。静脉给药法与口服给药法术后15 d、30 d再出血发生率未见明显差异[RR=1.01，95%CI(0.66，1.54)，P=0.98]，总输血量、术后死亡率、住院天数亦均未见明显差异(P分别为0.78，0.73，0.19)。[结论]在术后30 d再出血发生率、死亡率及住院天数方面，口服质子泵抑制剂可达到与静脉注射同样的效果。但因口服质子泵抑制剂简单易行，并在一定程度上节约医疗成本，故口服给药法在临床应用中占有一定优势。

关键词：质子泵抑制剂；消化道溃疡出血；内镜治疗；口服；静脉注射；给药方式；Meta分析

Meta-analysis of influence of proton pump inhibitors in different delivery ways on prognosis of patients with peptic ulcer bleeding

Ji Xiaoyan,Zhu Wenxia,Xie Ling

(The First Affiliated Hospital of Xinjiang Medical University，Xinjiang 830011 China)

Abstractobjective:To systematically evaluate the influence of proton pump inhibitors in different drug-delivery ways on the prognosis of patients with peptic ulcer bleeding,in order to provide evidences for the choice of proton pump inhibitors in drug-delivery way of patients with peptic ulcer bleeding.Methods:It searched the PubMed,EMBASE,Cochrane Library,CNKI,Wanfang Data，Chinese biomedical literature database(CBM),the retrieval defined for the database to March 2015.A randomized controlled trial(RCT) was collected on the effect of proton pump inhibitors in different delivery ways on the prognosis of patients with peptic ulcer bleeding.The RevMan5.3 software was used to carry out the Meta analysis.Results: There was no significant difference in the incidence of re-bleeding after 15 days and 30 days in intravenous injection and oral administration[RR=1.01，95%CI(0.66，1.54)，P=0.98].The total amount of blood transfusion,postoperative mortality and hospitalization also had no significant difference(P=0.78,0.73,0.19).Conclusion:In terms of incidence of re-bleeding on postoperative 30 days.mortality and length of stay in hospital,the effect of oral administration of proton pump inhibitor was similar to that of intravenous injection.But the oral adminitration of proton pump inhibitor was simple and easy to implement,and to a certain extent,it could save the medical cost.Therefore,the oral administration method had certain advantages in clinical application.

Key wordsproton pump inhibitors;peptic ulcer bleeding;endoscopic therapy;oral administration;intravenous injection;drug-delivery way;Meta-analysis

消化道出血是临床常见的急症之一，消化道溃疡、肿瘤、应激、外伤等均可导致消化道出血。而消化道溃疡则是引起消化道出血最常见的原因之一，约有50%的消化道出血是由消化道溃疡所致[1-2]。内镜止血是治疗消化道溃疡所致出血的有效治疗方式之一。研究显示，内镜止血可显著降低病人再出血率及死亡率[3-5]。然而，胃酸可影响血凝块的形成，增加病人再出血的风险[6]。……