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目的系统评价不同给药方案质子泵抑制剂对内镜治疗成功止血的消化性溃疡出血患者疗效的影响。方法计算机检索Pub Med、Cochrane Library、Web of Science、EMbase、CNKI、VIP、万方数据库和万方医学网,对纳入的文献进行质量评价与数据提取后,采用Rev Man 5.2和Stata 12.0软件对数据进行合并分析。结果共纳入22篇文献,2 808例患者。Meta分析结果显示不同质子泵抑制剂给药方案对死亡率、再出血率、外科手术率和住院时间的影响总体上无显著差异。但按前72 h给药剂量行亚组分析时发现,剂量(≤120 mg)组的30 d内再出血发生风险高于高剂量组30 d内再出血发生风险([RR(相对危险度,relative risk)=0.59,95%CI(0.37,0.94),P=0.03]),剂量(320 mg)组的72 h内再出血发生风险低于高剂量组([RR=1.92,95%CI(1.02,3.62),P=0.04])。在需输血量上,剂量(320 mg)组和间歇给药方案低于高剂量持续给药组([SMD(标准化均数差,standard mean difference)=0.33,95%CI(0.09,0.57),P=0.008]、[SMD=0.11,95%CI(0.01,0.20),P=0.03])。结论对于内镜下成功止血的消化性溃疡出血患者,前72 h内间歇性、非高剂量质子泵抑制剂给药方案并不劣于指南推荐的连续高剂量质子泵抑制剂治疗方案。临床上建议结合患者的依从性和医疗成本,内镜治疗成功后可在前72 h内采用每日至少静脉给药两次、累积给予320 mg质子泵抑制剂的间歇性给药方案,如患者耐受经口给药,则相同剂量及频次经口给药的方案可能更为合理。
Objective To evaluate the effects of proton pump inhibitors with different dosage regimens on the curative effect of peptic ulcer hemorrhage treated by endoscopic therapy. Methods The data of PubMed, Cochrane Library, Web of Science, EMbase, CNKI, VIP, Wanfang database and Wanfang medical network were searched by computer. After the quality evaluation and data extraction of the included documents, the data of Rev Man 5.2 and Stata 12.0 Perform a combined analysis. Results A total of 22 articles were included, with 2,808 patients. Meta-analysis showed no significant difference in the effects of different proton pump inhibitor dosing regimens on mortality, rebleeding rate, surgical rate and length of stay. However, in the subgroup analysis of the dose administered in the first 72 h, the risk of rebleeding within 30 days of the dose (≤120 mg) group was higher than that of the high dose group ([RR (relative risk, relative risk = 0.59,95% CI 0.37,0.94, P = .03]). The risk of rebleeding within 72 h was lower in the dose (320 mg) group than in the high dose group (RR = 1.92, 95% CI 1.02, 3.62), P = 0.04]). For transfusions, the dose (320 mg) group and intermittent dosing regimen were lower than the high-dose sustained-on group ([SMD (standard mean difference) = 0.33, 95% CI (0.09, 0.57) P = 0.008], [SMD = 0.11, 95% CI (0.01, 0.20), P = 0.03]). Conclusions For patients with peptic ulcer hemostasis under endoscopic hemorrhage, intermittent, non-high dose proton pump inhibitor dosing within the first 72 h is not inferior to the recommended continuous high dose proton pump inhibitor regimen. Clinical recommendations combined with patient compliance and medical costs, the success of endoscopic treatment within 72 hours before the use of intravenous at least twice daily, cumulative administration of 320 mg proton pump inhibitor intermittent dosing regimens, such as patients Tolerable to oral administration, then the same dose and frequency of oral administration of the program may be more reasonable.