美国胃肠病该协会（AGA）有关开据 NSAIDs处方的建议

衍生物类阿司匹林的应用于随之而来高发消化道败血症专家组合意拟定推荐设计方案来减小后果据英国胃肠黄热病会与会的多学科专家组简介，衍生物类阿司匹林给有哮喘的病患者提供了广阔的益处，但是保健机构在给病患者开据这类制剂之前，必须来作考虑它的随之而来后果。消化道出血是用到非类阿司匹林的最常见的不良反应，最主要上消化道和下消化道的败血症。轻微的消化道败血症，如潜在的有可能发炎性溃疡，年死亡率为用到者的1－4％。专家组的提问结果“关于拟定衍生物类阿司匹林最主要环乙酰－2以致于剂和对乙酰氨基酚的应用于设计方案提问会的共识”发表在英国胃肠黄热病会出版的9月份的《临床胃肠黄热病与肝脏黄热病》周刊上。“衍生物类阿司匹林是全世界应用于最广泛的制剂，而且广泛的应用于证实了它的药用价值和相对来说稳定性” 据阿拉巴马大学普雷斯顿分校内科学讲师，论文的主要作者C. Mel Wilcox博士简介。“但是，过去虽然充分认识了消化道败血症，而没认识到其心脏危险性，英国胃肠黄热病会与会协商会议来减小对应用于该类制剂的益处和消化道及高血压毒性的后果，从而改进对该类制剂的应用于。”估计全世界每年耗尽500亿对乙酰氨基酚片，其中英国大约6000万份处方开据了对乙酰氨基酚，并主要给老年病患者。这类制剂对急、慢性疼痛和骨骼关节出血等各个方面直接。但是，衍生物类阿司匹林的用到随之而来着轻微的危险性，最主要消化道、肾脏和高血压败血症，甚至最主要脑出血和哮喘。“我们高兴地看到衍生物类阿司匹林的消化道败血症和死亡者已经从1992年开始下降，我们视为这种状况归功于一下各个方面：小剂量用到衍生物类阿司匹林；降低了肠道百日咳的普及；减小了质子泵以致于剂的应用于；以及引进对消化道更是安全的衍生物类阿司匹林的应用于，如昔布类制剂。” Wilcox博士说是。“但是，保健机构和病患者必须明了该类制剂的相关后果来拟定衍生物类阿司匹林的最佳应用于设计方案。专家组为保健机构拟定了当他们在决定是否给病患者开衍生物类阿司匹林时的所列同意：评价治疗的哮喘和病患者发生消化道和高血压败血症的潜在危险性因子，并和病患者提问乳癌的潜在危险性因子。对后果和益处展开分析来取决于个体消化道和高血压危险性后，开据低后果的制剂。消化道发炎发生危险性大的病患者必须应用于消化道后果低的衍生物类阿司匹林，例如非抑制衍生物类阿司匹林；高血压事件发生后果大的病患者必须做苄基酶－2以致于剂治疗；有已知乳癌或高血压病后果的病患者必须做小剂量对乙酰氨基酚。限制所开衍生物类阿司匹林的时期内和剂量，以及征询并同意病患者展开衍生物类阿司匹林的联合治疗。在应用于衍生物类阿司匹林治疗之前，先处理肠道百日咳的感染，以致不减小并发消化性溃疡的后果。针对消化道败血症后果大的病患者拟定胃肠保护设计方案，如应用于米索之世界领先醇或质子泵以致于剂。“衍生物类阿司匹林的应用于随之而来低消化道败血症在诊断和治疗上很重要，” Wilcox博士解释说是。“更是好地认知低消化道发炎发生的后果和衍生物是减少衍生物类阿司匹林的用到危险性所必须的。”在协商会议后曾提问的解毒剂都是非类以致于出血反应的制剂，因此在学术上被视为是衍生物类阿司匹林。非抑制的衍生物类阿司匹林，最主要抗抑郁药、依托度酸和萘丁美醛，它们比其他衍生物类阿司匹林，例如舒林酸、噻唑美辛、吡罗昔康和醛咯酸对消化道具有更是高的稳定性。昔布类制剂是抑制环乙酰－2抑制剂。在新标准剂量下，扑热息痛不是衍生物类阿司匹林。英国胃肠黄热病会专家组由胃肠黄热病、风湿黄热病、心脏黄热病和内科学医师合组，他们在小组提问后，以当之前科研报告为基础拟定了这个设计方案。英国胃肠黄热病会举办的“关于衍生物类阿司匹林的应用于的协商会议”由TAP药品公司提供的一项无限成人教育基金资助。与会者的支出开销列入涵盖在稿内，在www.cghjournal.org. Nonsteroidal anti-inflammatory drugs use associated with higher gastrointestinal complications Consensus panel develops recommendations to minimize risks Nonsteroidal anti-inflammatory drugs (NSAIDs) provide a broad range of benefits for patients who require their use, but health care providers need to carefully consider the associated risks before prescribing these drugs for their patients, according to a multi-disciplinary panel of experts convened by the AGA Institute. Gastrointestinal (GI) morbidities are the most common adverse events associated with NSAID use, including complications in both the upper- and lower-GI tracts; serious GI complications, such as potentially fatal bleeding ulcers, occur in one to four percent of NSAID users annually. The findings of the panel, "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin," were published in the September issue of Clinical Gastroenterology and Hepatology, published by the American Gastroenterological Association (AGA) Institute. "NSAIDs are the most widely used medications in the world, and the broad use of these drugs confirms their effectiveness and relative safety," according to C. Mel Wilcox, MD, professor of medicine, University of Alabama at Birmingham, and lead author of the paper. "However, well-recognized GI complications and previously unrecognized cardiac risks he caused great concern about the use of these drugs among healthcare professionals. The AGA Institute convened the consensus conference to increase awareness about the benefits and the risks of GI and cardiovascular toxicities associated with these medications and to improve their use." An estimated 50 billion aspirin tablets are consumed worldwide and approximately 60 million prescriptions are written for NSAIDs each year in the U.S., predominantly for older patients. These drugs are effective in acute and chronic treatment of painful and inflammatory musculoskeletal conditions, among others. However, NSAID use is associated with several risks including GI, renal and cardiovascular complications, including heart failure and myocardial infarction. "We were pleased to note that both NSAID-associated GI complications and death he been decreasing since 1992, which we believe can be attributed to several factors: use of lower-dose NSAIDs; decreasing prevalence of H. pylori; increasing use of proton-pump inhibitors; and the introduction of NSAIDs with greater GI safety, such as coxibs," said Dr. Wilcox. "However, healthcare providers and patients need to be aware of the risks associated with these drugs to develop the best plan for using NSAID therapy." The panel developed the following recommendations for healthcare providers to use when determining whether to prescribe NSAID treatment to their patients: ◎Review the treatment indication and potential patient risk factors, both for GI and cardiovascular complications, and discuss potential cardiovascular risk factor modifications with their patients. ◎Prescribe lower-risk agents after conducting a risk-benefit ysis to determine the GI versus cardiovascular risks for each individual. Patients who are at greater risk of GI bleeding should receive NSAIDs with lower GI risks, such as nsNSAIDs; patients with a greater risk of cardiovascular events should not receive COX-2 inhibitors; and patients with known or a high risk of cardiovascular disease should receive low-dose aspirin. ◎Limit the duration and dosage of the prescribed NSAID and ask about and advise their patients on combination NSAID therapy. ◎Treat patients with H. pylori infection prior to beginning NSAID therapy so as not to increase the risk of complicated ulcers. ◎Institute gastroprotection methods, such as misoprostol or proton pump inhibitors (PPIs), for patients at high-risk of GI complications. "The association of NSAID use with lower-GI tract complications is important diagnostically and therapeutically," explained Dr. Wilcox. "A better understanding of risk factors for and mechanisms of lower-GI tract bleeding in NSAID users will be required to address risk reduction." All agents discussed during the consensus conference were nonsteroidal, inhibit inflammation, and thus are technically considered NSAIDs. Nonselective NSAIDs include ibuprofen, etodolac and nabumetone, which may he superior GI safety than other nsNSAIDs, such as sulindac, indomethacin, piroxicam and ketorolac. Coxibs are selective NSAIDs. In standard doses, acetaminophen is not an NSAID. The AGA Institute panel was comprised of physicians in gastroenterology, rheumatology, cardiology and internal medicine who developed the statement based on presentations of current scientific knowledge followed by group discussion. The AGA Institute "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents" was supported though an unrestricted educational grant from TAP Pharmaceutical Products Inc. Financial disclosures for conference participants are included in the manuscript at www.cghjournal.org.编辑：bluelove 编辑： Zhu