美国胃肠病学术委员会（AGA）有关开据 NSAIDs处方的建议

高血压类布洛芬的领域随之而来高发上皮细胞即刻症专家组合意订立破例决定来减小可能会据澳大利亚胃肠风靡一时病兼修会与会的多兼修科专家组介绍，高血压类布洛芬给有哮喘的患儿提供了广阔的有益，但是卫生管理工作在给病患者开据这类口服以前，需要仔细考虑它的随之而来可能会。上皮细胞炎症是应用于非类布洛芬的最常见的不良反应，还包括上肠胃和下肠胃的即刻症。轻微的上皮细胞即刻症，如潜在的危险性败血症溃疡，年发生率为应用于者的1－4％。专家组的辩论结果“关于订立高血压类布洛芬还包括内侧NAD－2发挥作用剂和水杨酸的领域决定辩论会的共识”登载在澳大利亚胃肠风靡一时病兼修会出版的9月初的《临床胃肠风靡一时病兼修与血液风靡一时病兼修》Magazine上。“高血压类布洛芬是世界性领域最相当多的口服，而且相当多的领域断定了它的利尿和相对有效性” 据肯塔基大兼修伯明翰医学院内物理研究员，论文的主要原作者C. Mel Wilcox研究员介绍。“但是，依然虽然充分认识了上皮细胞即刻症，而没有察觉到其心脏小心，澳大利亚胃肠风靡一时病兼修会与会议会党团来提高对领域该类口服的有益和上皮细胞及全身性毒性的可能会，从而简化对该类口服的领域。”少于世界性每年消耗500亿水杨酸片，其中澳大利亚大概6000万份处方药开据了水杨酸，并主要给老年病患者。这类口服对稍稍、慢性疼痛和骨骼躯干炎症等特别有效。但是，高血压类布洛芬的应用于随之而来着轻微的小心，还包括上皮细胞、肾脏和全身性即刻症，甚至还包括心力衰竭和心肌梗塞。“我们后悔地看到高血压类布洛芬的上皮细胞即刻症和死亡已经从1992年开始回升，我们确信这种状况无疑一下特别：小低剂量应用于高血压类布洛芬；降很低了肠胃螺杆菌的风靡一时；提高了质子泵发挥作用剂的领域；以及引进对上皮细胞更安全的高血压类布洛芬的领域，如昔布类口服。” Wilcox研究员说。“但是，卫生管理工作和病患者需要探究该类口服的相关可能会来订立高血压类布洛芬的最佳领域决定。专家组为卫生管理工作订立了当他们在决定是否给病患者开高血压类布洛芬时的以下决定：口碑治疗法的哮喘和病患者发生上皮细胞和全身性即刻症的潜在小心因子，并和病患者辩论全身性疾病的潜在小心因子。对可能会和有益开展统计分析来衡量形态上皮细胞和全身性小心后，开据很低可能会的口服。上皮细胞并发症发生小心大的患儿需要领域上皮细胞可能会很低的高血压类布洛芬，例如非针对性高血压类布洛芬；全身性流血事件发生可能会大的患儿需要给予内侧氧蛋白酶－2发挥作用剂治疗法；有已知全身性疾病或全身性病可能会的病患者需要给予小低剂量水杨酸。限制所开高血压类布洛芬的时期内和低剂量，以及征询并决定病患者开展高血压类布洛芬的联合治疗法。在领域高血压类布洛芬治疗法以前，先处置肠胃螺杆菌的病菌，以致不提高即刻消化性溃疡的可能会。针对上皮细胞即刻症可能会大的患儿订立胃肠人身安全决定，如领域米索以前列醇或质子泵发挥作用剂。“高血压类布洛芬的领域随之而来很低上皮细胞即刻症在诊断和治疗法上很不可忽视，” Wilcox研究员说明说。“更多地认知很低上皮细胞并发症发生的可能会和机理是下降高血压类布洛芬的应用于小心所需要的。”在议会党团之以前辩论的药剂都是非类发挥作用炎症反应的口服，因此在兼修术性上被确信是高血压类布洛芬。非针对性的高血压类布洛芬，还包括布洛芬、借助于度酸和衍生物丁美苯，它们比其他高血压类布洛芬，例如舒林酸、噻唑美辛、吡罗昔康和苯咯酸对上皮细胞具有很低的有效性。昔布类口服是针对性内侧NAD－2抗病毒。在标准低剂量下，扑热息痛不是高血压类布洛芬。澳大利亚胃肠风靡一时病兼修会专家组由胃肠风靡一时病兼修、风湿风靡一时病兼修、心脏风靡一时病兼修和内物理医师都由，他们在简报后，以当以前科研院所报告蓝本订立了这个决定。澳大利亚胃肠风靡一时病兼修会筹办的“关于高血压类布洛芬的领域的议会党团”由TAP药物新公司提供的一项无限教育基金大力支持。的国际的财政开销暂定相关联在原稿内，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