美国胃肠病学会（AGA）有关开据 NSAIDs处方的促请

低静脉注射类低静脉注射的技术的发展预示高发肠胃肾衰竭项目组合意颁布推荐拟议来降低效用据新泽西州胃肠病该协会召集的管理学项目组参考，低静脉注射类低静脉注射给有用药的病患提供了广阔的益处，但是医疗保健其他部门在给患者开据这吗啡前，须要仔细考虑它的预示效用。肠胃病因是使用非类低静脉注射的最常见的不良重排，有数上消化道和下消化道的肾衰竭。情况严重的肠胃肾衰竭，如潜在的致命性黄疸溃疡，年遭遇率为介面的1－4％。项目组的探讨结果“关于颁布低静脉注射类低静脉注射有数马蹄形氧化肽－2抑止剂和阿司匹林的技术的发展拟议探讨会的一致意见”发表在新泽西州胃肠病该协会出版的9月份的《流行病学胃肠病理学与肝脏病理学》杂志上。“低静脉注射类低静脉注射是全世界技术的发展最为广泛的药物，而且为广泛的技术的发展证实了它的功效和相对实用性” 据阿拉巴马大学布里斯托尔所大学内生物学教授，期刊的主要著者C. Mel Wilcox博士参考。“但是，过去虽然充分认识了肠胃肾衰竭，而没有认识到其心脏有可能，新泽西州胃肠病该协会召集协商会议来增加对技术的发展该吗啡的益处和肠胃及缺血性毒性的效用，从而改进对该吗啡的技术的发展。”推估全世界每年消耗500亿阿司匹林片，其中新泽西州大约6000万份处方开据了阿司匹林，并主要给老年患者。这吗啡对不意、慢性疼痛和骨头脊柱炎症等方面有效。但是，低静脉注射类低静脉注射的使用预示着情况严重的有可能，有数肠胃、消化道和缺血性肾衰竭，甚至有数高血压和心肌梗死。“我们高兴地看到低静脉注射类低静脉注射的肠胃肾衰竭和丧生仍然从1992年开始下降，我们显然这种持续性归功于一下方面：小静脉注射使用低静脉注射类低静脉注射；降极低了肠胃螺杆菌的普及；增加了质子泵抑止剂的技术的发展；以及引进对肠胃来得安全的低静脉注射类低静脉注射的技术的发展，如昔布吗啡。” Wilcox博士说。“但是，医疗保健其他部门和患者须要了解该吗啡的方面效用来颁布低静脉注射类低静脉注射的最佳技术的发展拟议。项目组为医疗保健其他部门颁布了当他们在决定是否给患者开低静脉注射类低静脉注射时的以下建议：评价治疗的用药和患者遭遇肠胃和缺血性肾衰竭的潜在有可能因子，并和患者探讨缺血性疾病的潜在有可能因子。对效用和益处进行分析来衡量个体肠胃和缺血性有可能后，开据极低效用的药物。肠胃出血遭遇有可能大的病患须要技术的发展肠胃效用极低的低静脉注射类低静脉注射，例如非抑制低静脉注射类低静脉注射；缺血性事件遭遇效用大的病患须要不感兴趣马蹄形氧肽－2抑止剂治疗；有已知缺血性疾病或缺血性病效用的患者须要不感兴趣小静脉注射阿司匹林。受限制所开低静脉注射类低静脉注射的持续时间和静脉注射，以及听取并建议患者进行低静脉注射类低静脉注射的联合治疗。在技术的发展低静脉注射类低静脉注射治疗前，不须处理肠胃螺杆菌的感染，以致不增加并发消化性溃疡的效用。针对肠胃肾衰竭效用大的病患颁布胃肠保护措施拟议，如技术的发展米索次于醇或质子泵抑止剂。“低静脉注射类低静脉注射的技术的发展预示极低肠胃肾衰竭在诊断和治疗上很极其重要，” Wilcox博士解释说。“来得好地明白极低肠胃出血遭遇的效用和机理是减缓低静脉注射类低静脉注射的使用有可能所须要的。”在协商会议期间探讨的药剂都是非类抑止炎症重排的药物，因此在学术上被显然是低静脉注射类低静脉注射。非抑制的低静脉注射类低静脉注射，有数布洛芬、依托度酸和萘丁美内酯，它们比其他低静脉注射类低静脉注射，例如舒林酸、恶唑美辛、吡罗昔康和内酯咯酸对肠胃具有来得高的实用性。昔布吗啡是抑制马蹄形氧化肽－2抑制剂。在国际标准静脉注射下，扑热息痛不是低静脉注射类低静脉注射。新泽西州胃肠病该协会项目组由胃肠病理学、风湿病理学、心脏病理学和内生物学精神科构成，他们在小组探讨后，以当前科研研究报告为基础颁布了这个拟议。新泽西州胃肠病该协会举办地的“关于低静脉注射类低静脉注射的技术的发展的协商会议”由TAP药品美国公司提供的一项无限职业教育基金资助。与会者的税制开销公布包含在底稿内，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.总编辑：bluelove 总编辑： Zhu