PDF(Pubmed)
Abstract：
After encountering a unique patient case, we revisit the updated literature on stress ulcer prophylaxis with more updated studies. A 47-year-old male came to the hospital and was found to have acute cholecystitis. After undergoing urgent cholecystectomy, the patient developed melena and a 6 mg/dL drop from 12.5 g/dL to 6.5 g/dL in hemoglobin. He was found to have a gastric ulcer and was started on a proton pump inhibitor, which posed the question of whether or not stress ulcer prophylaxis was indicated. Therefore, the pathophysiology of stress ulcer prophylaxis is refreshed, discussing the various mechanisms through which stress ulcers form in a clinical context. Then, the main risk factors and indications for stress ulcer prophylaxis are defined based on current literature, further investigating whether or not stress ulcer prophylaxis has shown benefit and protection in various patient groups. Additionally, this review discusses the adverse effects of stress ulcer prophylaxis, including dysbiosis, community-acquired pneumonia, nutritional deficiencies, drug interactions, and fractures. Finally, inappropriate stress ulcer prophylaxis and contributing factors to overutilization are discussed, and alternative approaches to prevent stress ulcer formation are covered, including early enteral nutrition. Overall, there are mixed conclusions on the effectiveness of stress ulcer prophylaxis in noncritical patients. There are many adverse effects and unnecessary costs associated with inappropriate administration, and many studies have found that it should be reserved for specific clinical indications.
摘要：
在遇到一个独特的病人病例后，我们通过更多更新的研究重新审视了有关预防应激性溃疡的最新文献.一名47岁的男性来到医院，被发现患有急性胆囊炎。在接受紧急胆囊切除术后,患者出现黑便,血红蛋白从12.5g/dL降至6.5g/dL,为6mg/dL.他被发现患有胃溃疡，开始服用质子泵抑制剂，这提出了是否需要预防应激性溃疡的问题。因此,预防应激性溃疡的病理生理学得到了更新，讨论临床背景下应激性溃疡形成的各种机制。然后，根据现有文献定义了预防应激性溃疡的主要危险因素和适应症，进一步研究预防应激性溃疡是否在不同患者组中显示出益处和保护作用。此外,这篇综述讨论了预防应激性溃疡的副作用，包括生态失调,社区获得性肺炎,营养缺乏,药物相互作用,和骨折。最后,讨论了不适当的应激性溃疡预防和过度利用的影响因素，并涵盖了预防应激性溃疡形成的替代方法，包括早期肠内营养。总的来说,关于非危重患者预防应激性溃疡的有效性，有不同的结论。管理不当会带来许多不利影响和不必要的成本,许多研究发现它应该保留用于特定的临床适应症。
