美国胃肠病学会（AGA）有关开据 NSAIDs处方的表示同意

继发类抗抑郁药的广泛应用伴随高发呼吸道出血学术委员会合意拟定推荐计划来减小几率据新泽西州消化道联合国开发计划署会听取的多学科学术委员会详述，继发类抗抑郁药给有预防性的病征发放了广袤的益处，但是护理业务部门在给疗法开据这类类固酯当年，只能精心考虑到它的伴随几率。呼吸道水肿是用作非类抗抑郁药的最类似的哮喘，最主要上消化道和下消化道的出血。严重的呼吸道出血，如潜在的致命性发炎性肿胀，年愈演愈烈率为用作者的1－4％。学术委员会的讨论结果“关于拟定继发类抗抑郁药最主要马蹄形氧化蛋白酶－2以致于剂和类固酯的广泛应用计划讨论会的协商”发表在新泽西州消化道联合国开发计划署会印行的9月份的《病理消化道联合国开发计划署与肝脏联合国开发计划署》杂志上。“继发类抗抑郁药是全世界广泛应用最为广泛的类固酯，而且为广泛的广泛应用属实了它的功效和相对来知道实用性” 据阿拉巴马国立大学普雷斯顿分校内医学博士，博士论文的主要作者C. Mel Wilcox芝加哥大学详述。“但是，过去虽然充分认识了呼吸道出血，而无法认识到其心脏险恶，新泽西州消化道联合国开发计划署会听取协商会议来增加对广泛应用该类类固酯的益处和呼吸道及全身性毒性的几率，从而简化对该类类固酯的广泛应用。”估计全世界每年消耗500亿类固酯片，其中新泽西州大约6000万份药开据了类固酯，并主要给老年疗法。这类类固酯对难、慢性疼痛和骨头关节发炎等各个方面适当。但是，继发类抗抑郁药的用作伴随着严重的险恶，最主要呼吸道、消化道和全身性出血，甚至最主要心力衰竭和心肌梗死。“我们就让地看到继发类抗抑郁药的呼吸道出血和死亡从未从1992年开始攀升，我们显然这种持续性并不认为一下各个方面：小较高剂量用作继发类抗抑郁药；减较高了消化道幽门的风靡；增加了质子泵以致于剂的广泛应用；以及引进对呼吸道非常必需的继发类抗抑郁药的广泛应用，如昔札类类固酯。” Wilcox芝加哥大学知道。“但是，护理业务部门和疗法只能了解该类类固酯的相关几率来拟定继发类抗抑郁药的最佳广泛应用计划。学术委员会为护理业务部门拟定了当他们在决定是否给疗法开继发类抗抑郁药时的下述决定：评价疗法的预防性和疗法愈演愈烈呼吸道和全身性出血的潜在险恶因子，并和疗法讨论全身性疾病的潜在险恶因子。对几率和益处完成分析来量度性状呼吸道和全身性险恶后，开据较高几率的类固酯。呼吸道发炎愈演愈烈险恶大的病征只能广泛应用呼吸道几率较高的继发类抗抑郁药，例如非特异性继发类抗抑郁药；全身性事件愈演愈烈几率大的病征只能给予马蹄形氧蛋白酶－2以致于剂疗法；有已知全身性疾病或全身性病几率的疗法只能给予小较高剂量类固酯。约束所开继发类抗抑郁药的持续时间和较高剂量，以及听取并决定疗法完成继发类抗抑郁药的联合疗法。在广泛应用继发类抗抑郁药疗法当年，先解决问题消化道幽门的传染，以致不增加并作消化性肿胀的几率。针对呼吸道出血几率大的病征拟定消化道保护措施计划，如广泛应用米索当年列酯或质子泵以致于剂。“继发类抗抑郁药的广泛应用伴随较高呼吸道出血在病因和疗法上很重要，” Wilcox芝加哥大学解释知道。“非常好地明白较高呼吸道发炎愈演愈烈的几率和机理是缩减继发类抗抑郁药的用作险恶所只能的。”在协商会议在此期间讨论的药剂都是非类以致于发炎反应的类固酯，因此在学术上被显然是继发类抗抑郁药。非特异性的继发类抗抑郁药，最主要甲酯、相结合度酸和萘丁美酮，它们比其他继发类抗抑郁药，例如舒林酸、哌啶美辛、吡罗昔康和酮咯酸对呼吸道不具非常高的实用性。昔札类类固酯是特异性马蹄形氧化蛋白酶－2抑制剂。在标准较高剂量下，扑热息痛不是继发类抗抑郁药。新泽西州消化道联合国开发计划署会学术委员会由消化道联合国开发计划署、风湿联合国开发计划署、心脏联合国开发计划署和内医学医师组成，他们在小组讨论后，以当当年科研院所通报辅以拟定了这个计划。新泽西州消化道联合国开发计划署会举办的“关于继发类抗抑郁药的广泛应用的协商会议”由TAP药品公司发放的一项无限教育基金捐献。与会者的税收所需定为包含在草稿内，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