美国胃肠病物理学会（AGA）有关开据 NSAIDs处方的建议

酮类类高于静脉注射的技术的发展随之而来高发胃肠道比方说症国家科委亦非实施推荐提案来减小风险据美国政府胃肠病该协会与会的多学科国家科委引介，酮类类高于静脉注射给有止痛的患者透过了广阔的好处，但是卫生保健部门在给病患开据这镇静剂从前，无需妥当考虑它的随之而来风险。胃肠道病因是常用非类高于静脉注射的最常见的不良反应，都有上胃肠道和下胃肠道的比方说症。严重的胃肠道比方说症，如潜在的致命性出血性溃疡，年频发率为常用者的1－4％。国家科委的争论结果“关于实施酮类类高于静脉注射都有环抗坏血酸－2持续性剂和类药物的技术的发展提案争论会的共识”刊载在美国政府胃肠病该协会出版的9月份的《临床胃肠药理学与肝脏药理学》华尔街日报上。“酮类类高于静脉注射是世界各地技术的发展最为广泛的药品，而且为广泛的技术的发展声称了它的利尿和相比较公共可靠度” 据阿拉巴马大学伯明翰校本部内科学知识教授，专著的主要作者C. Mel Wilcox芝加哥大学引介。“但是，依然虽然充分认识了胃肠道比方说症，而不会认识到其瓣膜生命危险，美国政府胃肠病该协会与会议会党团来缩减对技术的发展该镇静剂的好处和胃肠道及冠心病毒性的风险，从而改进对该镇静剂的技术的发展。”估计世界各地每年浪费500亿类药物片，其中美国政府大约6000万份药品开据了类药物，并主要给老年病患。这镇静剂对稍稍、病症和骨骼手部炎症等上都必要。但是，酮类类高于静脉注射的常用随之而来着严重的生命危险，都有胃肠道、肾脏和冠心病比方说症，甚至都有心肌梗死和哮喘。“我们吃惊地认出酮类类高于静脉注射的胃肠道比方说症和丧命已经从1992年开始减少，我们显然这种现状众所周知一下上都：小静脉注射常用酮类类高于静脉注射；降高于了肠道索斯尼夫卡的风靡；缩减了质子泵持续性剂的技术的发展；以及引进对胃肠道愈来愈公共安全的酮类类高于静脉注射的技术的发展，如昔布镇静剂。” Wilcox芝加哥大学说。“但是，卫生保健部门和病患无需了解该镇静剂的关的风险来实施酮类类高于静脉注射的最佳技术的发展提案。国家科委为卫生保健部门实施了当他们在决定是否给病患开酮类类高于静脉注射时的下述同意：评价疗法的止痛和病患频发胃肠道和冠心病比方说症的潜在生命危险系数，并和病患争论冠心病疾病的潜在生命危险系数。对风险和好处顺利完成分析来衡量个体胃肠道和冠心病生命危险后，开据高于风险的药品。胃肠道出血频发生命危险大的患者无需技术的发展胃肠道风险高于的酮类类高于静脉注射，例如非软性酮类类高于静脉注射；冠心病事件频发风险大的患者无需不能接受环氧酵素－2持续性剂疗法；有存留冠心病疾病或冠心病病风险的病患无需不能接受小静脉注射类药物。限制所开酮类类高于静脉注射的持续时间和静脉注射，以及征求并同意病患顺利完成酮类类高于静脉注射的联合疗法。在技术的发展酮类类高于静脉注射疗法从前，先处理过程肠道索斯尼夫卡的感染，以致不缩减比方说消化性溃疡的风险。针对胃肠道比方说症风险大的患者实施胃肠保护提案，如技术的发展米索从前列酮或质子泵持续性剂。“酮类类高于静脉注射的技术的发展随之而来高于胃肠道比方说症在诊断和疗法上很重要，” Wilcox芝加哥大学解释说。“愈来愈快地认知高于胃肠道出血频发的风险和衍生物是减少酮类类高于静脉注射的常用生命危险所无需的。”在议会党团其间争论的化学物质都认类持续性炎症反应的药品，因此在社会科学上被显然是酮类类高于静脉注射。非软性的酮类类高于静脉注射，都有布洛芬、依托度酸和萘丁美酮，它们比其他酮类类高于静脉注射，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对胃肠道具有愈来愈高的公共可靠度。昔布镇静剂是软性环抗坏血酸－2抗病毒。在标准静脉注射下，扑热息痛不是酮类类高于静脉注射。美国政府胃肠病该协会国家科委由胃肠药理学、风湿药理学、瓣膜药理学和内科学知识外科组成，他们在小组争论后，以当从前科研统计数据为基础实施了这个提案。美国政府胃肠病该协会举办的“关于酮类类高于静脉注射的技术的发展的议会党团”由TAP药品公司透过的一项无限成人教育投资基金资助。的国际的财政现状数据量公布包含在原稿内，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