American胃肠病学会（AGA）有关开据 NSAIDs处方的建议

高血压类抗抑郁药的系统设计显现出高发小肠癌症指导委员会原则上制定推荐可行性来减小稳定性据加拿大胃肠病兼修会招集的兼修科指导委员会简述，高血压类抗抑郁药给有适应症的医护人员提供了广阔的更进一步，但是医疗卫生管理机构在给医护人员掀开据这抗抑郁药前，只能来作回避它的显现出稳定性。小肠病变是适用非类抗抑郁药的最常见的哮喘，包括上十二指肠和下十二指肠的癌症。严重影响的小肠癌症，如潜在的不太可能肿胀性溃疡，年暴发率为适用者的1－4％。指导委员会的发表意见结果“关于制定高血压类抗抑郁药包括环中氧化酶－2正因如此剂和药物的系统设计可行性发表意见会的一致”发表在加拿大胃肠病兼修会出版的9月份的《临床胃肠病兼修与肝脏病兼修》月刊上。“高血压类抗抑郁药是当今世界系统设计最普遍的口服，而且普遍的系统设计证实了它的效用和相对来说是人身稳定性” 据阿拉巴马大兼修伯明翰所兼修院内现代科兼修副教授，论文的主要作者C. Mel Wilcox博士简述。“但是，过去虽然充分认识了小肠癌症，而没有意识到其肝脏小心，加拿大胃肠病兼修会招集地方议会来降低对系统设计该抗抑郁药的更进一步和小肠及高血压毒性的稳定性，从而改进对该抗抑郁药的系统设计。”估计当今世界每年消耗500亿药物片，其中加拿大大约6000万份处方掀开据了药物，并主要给老年医护人员。这抗抑郁药对引、心理因素和骨骼肌肉瘙痒等之外有效。但是，高血压类抗抑郁药的适用显现出着严重影响的小心，包括小肠、肾脏和高血压癌症，甚至包括心力衰竭和心肌梗死。“我们高兴地看到高血压类抗抑郁药的小肠癌症和生还并未从1992年掀开始减少，我们确信这种状况得益于一下之外：小mg适用高血压类抗抑郁药；降较高了幽门特罗斯季亚涅齐的风靡一时；降低了质子泵正因如此剂的系统设计；以及应运而生对小肠更人身安全的高血压类抗抑郁药的系统设计，如昔托抗抑郁药。” Wilcox博士说是。“但是，医疗卫生管理机构和医护人员只能洞察该抗抑郁药的具体稳定性来制定高血压类抗抑郁药的最佳系统设计可行性。指导委员会为医疗卫生管理机构制定了当他们在暂时是否给医护人员掀开高血压类抗抑郁药时的以下提议：评价疗程的适应症和医护人员暴发小肠和高血压癌症的潜在小心表征，并和医护人员发表意见高血压疾病的潜在小心表征。对稳定性和更进一步同步进行数据分析来衡量标准母体小肠和高血压小心后，掀开据较高稳定性的口服。小肠肿胀暴发小心大的医护人员只能系统设计小肠稳定性较高的高血压类抗抑郁药，例如非胺类高血压类抗抑郁药；高血压事件暴发稳定性大的医护人员只能做环中氧酶－2正因如此剂疗程；有已知高血压疾病或高血压病稳定性的医护人员只能做小mg药物。限制所掀开高血压类抗抑郁药的持续时间和mg，以及发表意见并提议医护人员同步进行高血压类抗抑郁药的联合疗程。在系统设计高血压类抗抑郁药疗程前，先处理幽门特罗斯季亚涅齐的感染，以致不降低并发消化性溃疡的稳定性。针对小肠癌症稳定性大的医护人员制定胃肠保护可行性，如系统设计米索前三位醇或质子泵正因如此剂。“高血压类抗抑郁药的系统设计显现出较高小肠癌症在诊断和疗程上很重要，” Wilcox博士解释说是。“好处地表达出来较高小肠肿胀暴发的稳定性和分子结构是提高高血压类抗抑郁药的适用小心所只能的。”在地方议会期间发表意见的药剂都是非类正因如此瘙痒重排的口服，因此在社会现代科兼修上被确信是高血压类抗抑郁药。非胺类的高血压类抗抑郁药，包括胺类、相结合度酸和萘丁美酮，它们比其他高血压类抗抑郁药，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对小肠具有很低的人身稳定性。昔托抗抑郁药是胺类环中氧化酶－2抑制剂。在标准mg下，扑热息痛不是高血压类抗抑郁药。加拿大胃肠病兼修会指导委员会由胃肠病兼修、风湿病兼修、肝脏病兼修和内现代科兼修护理人员都是由，他们在小组发表意见后，以当前工程技术报告为基础制定了这个可行性。加拿大胃肠病兼修会举办的“关于高血压类抗抑郁药的系统设计的地方议会”由TAP酒类一些公司提供的一项无限教育基金支助。与会者的财政掀开销公托包含在手稿内，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