J Gastrointest Surg:内窥镜粘膜下层剥离术后禁食期间静脉注射质子泵抑制剂对预防出血的影响

2021-07-26 MedSci原创 MedSci原创

对于接受内窥镜粘膜下剥离术(ESD)的患者的最佳围手术期策略,目前尚未达成共识。近日,一项单一中心进行的前瞻性、随机、双盲、安慰剂对照试验调查了在ESD后禁食期间静脉注射质子泵抑制剂(PPI)对ESD

对于接受内窥镜粘膜下剥离术(ESD)的患者的最佳围手术期策略,目前尚未达成共识。近日,一项单一中心进行的前瞻性、随机、双盲、安慰剂对照试验调查了在ESD后禁食期间静脉注射质子泵抑制剂(PPI)对ESD后延迟出血的影响,研究结果已发表于J Gastrointest Surg。

2016年3月至2018年9月期间,研究共纳入235名接受ESD治疗腺瘤和早期胃癌的患者,随机分为PPI组和安慰剂组。患者在ESD后48小时的禁食期(从ESD当天到第二天,48小时),每天静脉注射泮托拉唑40毫克(PPI组)或安慰剂(安慰剂组)。口服后(ESD后48 h),两组均口服PPI,持续8周。

 

结果显示,在有意治疗(ITT)的235名患者和按方案(PP)分析的195名患者中,PPI组和对照组在ESD后的大出血(PPI vs. 安慰剂;3.3% vs. 1.7%,p = 0.27)或小出血(PPI vs. 安慰剂;7.6% vs. 4.3%,p = 0.41)方面没有显著差异。两组之间在年龄(p = 0.28)、组织学(p = 0.75)、肿瘤大小(p = 0.48)或手术时间(p = 0.49)方面没有显著差异。主要延迟出血的唯一独立风险因素是联合使用阿司匹林和抗血小板药物(OR;12.25,95% CI;1.06-141.19,p = 0.04)。

综上,该研究结果表明,在ESD后48小时的空腹期给予常规静脉注射PPI并不能减少ESD后的延迟出血。

 

原始出处:

 

Jai Hoon Yoon, et al., Effect on Bleeding Prevention of an Intravenous Proton Pump Inhibitor During the Fasting Period After Endoscopic Submucosal Dissection: a Prospective, Randomized, Double-Blind, Placebo-Controlled Trial. J Gastrointest Surg. 2020 Nov;24(11):2596-2601. doi: 10.1007/s11605-019-04466-9.  

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    2022-02-12 jklm09
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createdName=jklm09, createdTime=Sat Feb 12 02:37:48 CST 2022, time=2022-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712872, encodeId=31381e128720b, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Thu Jun 02 06:37:48 CST 2022, time=2022-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691095, encodeId=cdc6169109509, content=<a href='/topic/show?id=7adce62603e' target=_blank style='color:#2F92EE;'>#粘膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76260, encryptionId=7adce62603e, topicName=粘膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=090129165428, createdName=guoyibin, createdTime=Sun Oct 03 18:37:48 CST 2021, time=2021-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698241, encodeId=c74f1698241e2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Sun May 29 21:37:48 CST 2022, time=2022-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2073396, encodeId=78de20e3396ab, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Thu Sep 02 04:37:48 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1667403, encodeId=8b0f166e40326, content=<a href='/topic/show?id=03ab923565b' target=_blank style='color:#2F92EE;'>#质子泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92356, encryptionId=03ab923565b, topicName=质子泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=761326143554, createdName=shenxlcyp, createdTime=Wed Jun 08 03:37:48 CST 2022, time=2022-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943417, encodeId=101e194341e33, content=<a href='/topic/show?id=fa761e2916a' target=_blank style='color:#2F92EE;'>#Test#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17291, encryptionId=fa761e2916a, topicName=Test)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aea0290, createdName=lqvr, createdTime=Tue Nov 02 13:37:48 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481582, encodeId=949a1481582f1, content=<a href='/topic/show?id=0641304e995' target=_blank style='color:#2F92EE;'>#内窥镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30479, encryptionId=0641304e995, topicName=内窥镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db497802700, createdName=紫砂壶, createdTime=Wed Jul 28 03:37:48 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492527, encodeId=2f00149252e9e, content=<a href='/topic/show?id=685199141a6' target=_blank style='color:#2F92EE;'>#静脉注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99141, encryptionId=685199141a6, topicName=静脉注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77e28942453, createdName=millore, createdTime=Wed Jul 28 03:37:48 CST 2021, time=2021-07-28, status=1, ipAttribution=)]
    2021-10-03 guoyibin
  5. [GetPortalCommentsPageByObjectIdResponse(id=2051673, encodeId=53b420516e360, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Sat Dec 04 04:37:48 CST 2021, time=2021-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852716, encodeId=c51e1852e16ee, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, createdName=jklm09, createdTime=Sat Feb 12 02:37:48 CST 2022, time=2022-02-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1712872, encodeId=31381e128720b, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Thu Jun 02 06:37:48 CST 2022, time=2022-06-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1691095, encodeId=cdc6169109509, content=<a href='/topic/show?id=7adce62603e' target=_blank style='color:#2F92EE;'>#粘膜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76260, encryptionId=7adce62603e, topicName=粘膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=090129165428, createdName=guoyibin, createdTime=Sun Oct 03 18:37:48 CST 2021, time=2021-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698241, encodeId=c74f1698241e2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Sun May 29 21:37:48 CST 2022, time=2022-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2073396, encodeId=78de20e3396ab, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Thu Sep 02 04:37:48 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1667403, encodeId=8b0f166e40326, content=<a href='/topic/show?id=03ab923565b' target=_blank style='color:#2F92EE;'>#质子泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92356, encryptionId=03ab923565b, topicName=质子泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=761326143554, createdName=shenxlcyp, createdTime=Wed Jun 08 03:37:48 CST 2022, time=2022-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943417, encodeId=101e194341e33, content=<a href='/topic/show?id=fa761e2916a' target=_blank style='color:#2F92EE;'>#Test#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17291, encryptionId=fa761e2916a, topicName=Test)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aea0290, createdName=lqvr, createdTime=Tue Nov 02 13:37:48 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481582, encodeId=949a1481582f1, content=<a href='/topic/show?id=0641304e995' target=_blank style='color:#2F92EE;'>#内窥镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30479, encryptionId=0641304e995, topicName=内窥镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db497802700, createdName=紫砂壶, createdTime=Wed Jul 28 03:37:48 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492527, encodeId=2f00149252e9e, content=<a href='/topic/show?id=685199141a6' target=_blank style='color:#2F92EE;'>#静脉注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99141, encryptionId=685199141a6, topicName=静脉注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77e28942453, createdName=millore, createdTime=Wed Jul 28 03:37:48 CST 2021, time=2021-07-28, status=1, ipAttribution=)]
    2022-05-29 fusion
  6. [GetPortalCommentsPageByObjectIdResponse(id=2051673, encodeId=53b420516e360, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Sat Dec 04 04:37:48 CST 2021, time=2021-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852716, encodeId=c51e1852e16ee, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, 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encryptionId=7adce62603e, topicName=粘膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=090129165428, createdName=guoyibin, createdTime=Sun Oct 03 18:37:48 CST 2021, time=2021-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698241, encodeId=c74f1698241e2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Sun May 29 21:37:48 CST 2022, time=2022-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2073396, encodeId=78de20e3396ab, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Thu Sep 02 04:37:48 CST 2021, time=2021-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1667403, encodeId=8b0f166e40326, content=<a href='/topic/show?id=03ab923565b' target=_blank style='color:#2F92EE;'>#质子泵#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92356, encryptionId=03ab923565b, topicName=质子泵)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=761326143554, createdName=shenxlcyp, createdTime=Wed Jun 08 03:37:48 CST 2022, time=2022-06-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1943417, encodeId=101e194341e33, content=<a href='/topic/show?id=fa761e2916a' target=_blank style='color:#2F92EE;'>#Test#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17291, encryptionId=fa761e2916a, topicName=Test)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=aea0290, createdName=lqvr, createdTime=Tue Nov 02 13:37:48 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1481582, encodeId=949a1481582f1, content=<a href='/topic/show?id=0641304e995' target=_blank style='color:#2F92EE;'>#内窥镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30479, encryptionId=0641304e995, topicName=内窥镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=db497802700, createdName=紫砂壶, createdTime=Wed Jul 28 03:37:48 CST 2021, time=2021-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492527, encodeId=2f00149252e9e, content=<a href='/topic/show?id=685199141a6' target=_blank style='color:#2F92EE;'>#静脉注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99141, encryptionId=685199141a6, topicName=静脉注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77e28942453, createdName=millore, createdTime=Wed Jul 28 03:37:48 CST 2021, time=2021-07-28, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2051673, encodeId=53b420516e360, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Sat Dec 04 04:37:48 CST 2021, time=2021-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1852716, encodeId=c51e1852e16ee, content=<a href='/topic/show?id=f0a254918f0' target=_blank style='color:#2F92EE;'>#抑制剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=54918, encryptionId=f0a254918f0, topicName=抑制剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=44a360, 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encryptionId=7adce62603e, topicName=粘膜)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=090129165428, createdName=guoyibin, createdTime=Sun Oct 03 18:37:48 CST 2021, time=2021-10-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1698241, encodeId=c74f1698241e2, content=<a href='/topic/show?id=f2399910109' target=_blank style='color:#2F92EE;'>#静脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99101, encryptionId=f2399910109, topicName=静脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0bc129907796, createdName=fusion, createdTime=Sun May 29 21:37:48 CST 2022, time=2022-05-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2073396, encodeId=78de20e3396ab, content=<a href='/topic/show?id=9d4ee84647' target=_blank style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, 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  8. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1492527, encodeId=2f00149252e9e, content=<a href='/topic/show?id=685199141a6' target=_blank style='color:#2F92EE;'>#静脉注射#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=99141, encryptionId=685199141a6, topicName=静脉注射)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77e28942453, createdName=millore, createdTime=Wed Jul 28 03:37:48 CST 2021, time=2021-07-28, status=1, ipAttribution=)]
    2021-11-02 lqvr
  9. 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