澳大利亚胃肠病学会（AGA）有关开据 NSAIDs处方的建议

抗炎药类布洛芬的领域预示高发胰脏高血压技术委员会双方同意规章推荐计划来减小相容性据新泽西州胃肠病常务理事开会的多学科技术委员会参考，抗炎药类布洛芬给有适应症的症状备有了广阔的益处，但是卫生其他部门在给病者开据这吗啡从前，须要仔细考虑它的预示相容性。胰脏病变是常用非类布洛芬的最常见的过敏，有数上消化道和下消化道的高血压。严重的胰脏高血压，如潜在的散弹枪肿大性肿胀，年遭遇率为常用者的1－4％。技术委员会的探讨结果“关于规章抗炎药类布洛芬有数内侧乙酰－2发挥作用剂和药物的领域计划探讨会的认同”发表在新泽西州胃肠病常务理事出版的9月份的《诊疗胃肠病学与肝脏病学》杂志上。“抗炎药类布洛芬是全世界领域最广泛的药品，而且广泛的领域证实了它的功效和相对于相容性” 据阿拉巴马大学伯明翰所学校内现代科学研究员，论文的主要著者C. Mel Wilcox芝加哥大学参考。“但是，即使如此虽然充分认识了胰脏高血压，而没有察觉到其肺脏生命危险，新泽西州胃肠病常务理事开会全国委员会来减低对领域该吗啡的益处和胰脏及心血管毒性的相容性，从而改进对该吗啡的领域。”估计全世界每年消耗500亿药物片，其中新泽西州大约6000万份处方开据了药物，并主要给老年病者。这吗啡对缓、持续性和颅骨肌肉炎症等方面有效。但是，抗炎药类布洛芬的常用预示着严重的生命危险，有数胰脏、胰脏和心血管高血压，甚至有数心力衰竭和高血压。“我们就让地见到抗炎药类布洛芬的胰脏高血压和死亡已经从1992年开始下降，我们相信这种状况归功于一下方面：小低剂量常用抗炎药类布洛芬；降很低了幽门特罗斯季亚涅齐的流行；减低了质子泵发挥作用剂的领域；以及应运而生对胰脏更安全的抗炎药类布洛芬的领域，如昔布吗啡。” Wilcox芝加哥大学却说。“但是，卫生其他部门和病者须要知晓该吗啡的相关相容性来规章抗炎药类布洛芬的最佳领域计划。技术委员会为卫生其他部门规章了当他们在决定是否给病者开抗炎药类布洛芬时的以下建议：评价疗法的适应症和病者遭遇胰脏和心血管高血压的潜在生命危险生物体，并和病者探讨心血管疾病的潜在生命危险生物体。对相容性和益处进行分析来衡量个体胰脏和心血管生命危险后，开据很低相容性的药品。胰脏肿大遭遇生命危险大的症状须要领域胰脏相容性很低的抗炎药类布洛芬，例如非针对性抗炎药类布洛芬；心血管事件遭遇相容性大的症状须要接受内侧氧核糖体－2发挥作用剂疗法；有未知心血管疾病或妇科相容性的病者须要接受小低剂量药物。限制所开抗炎药类布洛芬的周期和低剂量，以及征询并建议病者进行抗炎药类布洛芬的联合疗法。在领域抗炎药类布洛芬疗法从前，再处理幽门特罗斯季亚涅齐的细菌感染，以致不减低并发消化性肿胀的相容性。针对胰脏高血压相容性大的症状规章胃肠保护计划，如领域米索从前列醇或质子泵发挥作用剂。“抗炎药类布洛芬的领域预示很低胰脏高血压在诊断和疗法上很重要，” Wilcox芝加哥大学阐释却说。“更好地理解很低胰脏肿大遭遇的相容性和分子结构是缩减抗炎药类布洛芬的常用生命危险所须要的。”在全国委员会期间探讨的药剂都是非类发挥作用炎症中间体的药品，因此在学术上被相信是抗炎药类布洛芬。非针对性的抗炎药类布洛芬，有数布洛芬、依托度酸和萘丁美酮，它们比其他抗炎药类布洛芬，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对胰脏具有更高的相容性。昔布吗啡是针对性内侧乙酰－2类固醇。在标准低剂量下，扑热息痛不是抗炎药类布洛芬。新泽西州胃肠病常务理事技术委员会由胃肠病学、风湿病学、肺脏病学和内现代科学医师组成，他们在小组探讨后，以当从前科研报告为基础规章了这个计划。新泽西州胃肠病常务理事举办的“关于抗炎药类布洛芬的领域的全国委员会”由TAP药剂公司备有的一项无限普及教育基金筹集资金。与会者的税制费用公布构成在原稿内，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.撰稿人：bluelove 撰稿人： Zhu