英国胃肠病学会（AGA）有关开据 NSAIDs处方的建议

高血压类较差剂量的应用于值得注意高发中枢神经胃癌初步合意订定推荐方案来减小高风险据宾夕法尼亚州胃肠病该学会商量的多学科初步介绍，高血压类较差剂量给有化学疗法的病变缺少了大片的或许，但是医疗卫生管理工作在给病患掀开据这类制剂此前，需仔细考虑它的值得注意高风险。中枢神经病变是使用非类较差剂量的最类似的不良反应，仅限于上消化道和下消化道的胃癌。情况严重的中枢神经胃癌，如潜在的致命性高血压溃疡，年频发率为使用者的1－4％。初步的争论结果“关于订定高血压类较差剂量仅限于酰胺化肽－2持续性剂和高血压的应用于方案争论会的实质”发表文章在宾夕法尼亚州胃肠病该学会出版发行的9当月的《病理胃肠病学与肝脏病学》刊物上。“高血压类较差剂量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消炎和相比较安全性” 据密苏里大学伯明翰分校内科学教授，论文的主要作者C. Mel Wilcox博士介绍。“但是，即使如此虽然充分认识了中枢神经胃癌，而不会认识到其心脏危险性，宾夕法尼亚州胃肠病该学会商量全国委员会来增加对应用于该类制剂的或许和中枢神经及心血管口服的高风险，从而改进对该类制剂的应用于。”估计全世界每年耗损500亿高血压片，其中宾夕法尼亚州大约6000万份本品掀开据了高血压，并主要给老年病患。这类制剂对稍稍、慢性疼痛和骨骼肌肉增生等方面有效。但是，高血压类较差剂量的使用值得注意着情况严重的危险性，仅限于中枢神经、肾脏和心血管胃癌，甚至仅限于心力衰竭和心肌梗死。“我们欣慰地看到高血压类较差剂量的中枢神经胃癌和死亡已经从1992年掀开始下降，我们认为这种情形归功于一下方面：小剂量使用高血压类较差剂量；降较差了幽门螺杆菌的大行其道；增加了质子泵持续性剂的应用于；以及引进对中枢神经更安全的高血压类较差剂量的应用于，如昔布类制剂。” Wilcox博士时说。“但是，医疗卫生管理工作和病患需了解该类制剂的特别高风险来订定高血压类较差剂量的最佳应用于方案。初步为医疗卫生管理工作订定了当他们在决定是否给病患掀开高血压类较差剂量时的以下建议：评价放射治疗的化学疗法和病患频发中枢神经和心血管胃癌的潜在危险性q，并和病患争论心血管疾病的潜在危险性q。对高风险和或许进行分析来衡量群体中枢神经和心血管危险性后，掀开据较差高风险的制剂。中枢神经坏死频发危险性大的病变需应用于中枢神经高风险较差的高血压类较差剂量，例如非软性高血压类较差剂量；心血管事件频发高风险大的病变需给与酰胺肽－2持续性剂放射治疗；有可知心血管疾病或心血管病高风险的病患需给与小剂量高血压。限制所掀开高血压类较差剂量的一段时间内和剂量，以及征询并建议病患进行高血压类较差剂量的联合放射治疗。在应用于高血压类较差剂量放射治疗此前，先处理幽门螺杆菌的感染，以致不增加所发消化性溃疡的高风险。针对中枢神经胃癌高风险大的病变订定胃肠保护方案，如应用于米索此前列醇或质子泵持续性剂。“高血压类较差剂量的应用于值得注意较差中枢神经胃癌在诊断和放射治疗上很极为重要，” Wilcox博士理解时说。“能够地理解较差中枢神经坏死频发的高风险和中间体是减少高血压类较差剂量的使用危险性所需的。”在全国委员会在此期间争论的药剂都有无类持续性增生反应的制剂，因此在学术上被认为是高血压类较差剂量。非软性的高血压类较差剂量，仅限于布洛芬、相结合度酸和萘丁美内酯，它们比其他高血压类较差剂量，例如舒林酸、咪唑美辛、吡罗昔康和内酯咯酸对中枢神经具有较高的安全性。昔布类制剂是软性酰胺化肽－2类似物。在新标准剂量下，扑热息痛不是高血压类较差剂量。宾夕法尼亚州胃肠病该学会初步由胃肠病学、风湿病学、心脏病学和内科学精神科组成，他们在小组争论后，以当此前科研人员报告为基础订定了这个方案。宾夕法尼亚州胃肠病该学会举办的“关于高血压类较差剂量的应用于的全国委员会”由TAP药品公司缺少的一项无限教育慈善机构资助。与会者的财政掀开销公布包含在稿本内，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：bluelove 总编： Zhu