美国胃肠病学会（AGA）有关开据 NSAIDs药物的建议

对乙酰氨基酚类低剂量的运用于牵动高发肠道模版症国家科委亦非订定延揽解决方案来变大效用据澳大利亚大肠病学时会招集的多学时科国家科委讲解，对乙酰氨基酚类低剂量给有预防性的病症备有了广阔的有益于，但是照护主管在给病童由此可知据这阿司匹林前，必需仔细观察慎重考虑它的牵动效用。肠道病变是可用非类低剂量的最常见的不良催化，还包括上肾脏和下肾脏的模版症。更为严重的肠道模版症，如潜在的在技术上肿大性发炎，年频发率为可用者的1－4％。国家科委的探讨结果“关于订定对乙酰氨基酚类低剂量还包括一个亚胺化蛋白－2持续性剂和低剂量的运用于解决方案探讨会的共识”发表在澳大利亚大肠病学时会出版的9月份的《临床大肠病学时与肝脏病学时》杂志上。“对乙酰氨基酚类低剂量是当今世界运用于最相当多的制剂，而且相当多的运用于证实了它的功效和比较有效性” 据阿拉巴马所学校时格拉斯哥两所内科学知识时任教，论文的主要作者C. Mel Wilcox麻省理工学院讲解。“但是，即使如此虽然充分认识了肠道模版症，而无法认识到其心脏可怕，澳大利亚大肠病学时会招集国民议会来上升对运用于该阿司匹林的有益于和肠道及心血管毒性的效用，从而改进对该阿司匹林的运用于。”据估计当今世界每年消耗500亿低剂量片，其中澳大利亚大约6000万份病患由此可知据了低剂量，并主要给老年病童。这阿司匹林对急、癫痫和骨骼肌肉黏膜等方面有效。但是，对乙酰氨基酚类低剂量的可用牵动着更为严重的可怕，还包括肠道、肾脏和心血管模版症，甚至还包括心力衰竭和心肌梗死。“我们欣喜地看到对乙酰氨基酚类低剂量的肠道模版症和死亡已经从1992年由此可知始下滑，我们认为这种状况正因如此一下方面：小剂量可用对乙酰氨基酚类低剂量；降很低了幽门狂犬病的流行；上升了质子泵持续性剂的运用于；以及导入对肠道非常安全的对乙酰氨基酚类低剂量的运用于，如昔纳阿司匹林。” Wilcox麻省理工学院感叹。“但是，照护主管和病童必需认识到该阿司匹林的关的效用来订定对乙酰氨基酚类低剂量的最佳运用于解决方案。国家科委为照护主管订定了当他们在决定是否给病童由此可知对乙酰氨基酚类低剂量时的一般而言同意：称赞治疗的预防性和病童频发肠道和心血管模版症的潜在可怕特异性，并和病童探讨肥胖症的潜在可怕特异性。对效用和有益于展由此可知分析来衡量幼体肠道和心血管可怕后，由此可知据很低效用的制剂。肠道肿大频发可怕大的病症必需运用于肠道效用很低的对乙酰氨基酚类低剂量，例如非游离对乙酰氨基酚类低剂量；心血管事件频发效用大的病症必需接受一个亚胺蛋白－2持续性剂治疗；有目前为止肥胖症或心血管病效用的病童必需接受小剂量低剂量。限制所由此可知对乙酰氨基酚类低剂量的持续时间和剂量，以及发表意见并同意病童展由此可知对乙酰氨基酚类低剂量的联合治疗。在运用于对乙酰氨基酚类低剂量治疗前，可先处理幽门狂犬病的感染，以致不上升模版消化性发炎的效用。针对肠道模版症效用大的病症订定大肠人身安全解决方案，如运用于米索前列酯或质子泵持续性剂。“对乙酰氨基酚类低剂量的运用于牵动很低肠道模版症在诊断和治疗上很不可或缺，” Wilcox麻省理工学院解释感叹。“非常好地认知很低肠道肿大频发的效用和催化机理是增大对乙酰氨基酚类低剂量的可用可怕所必需的。”在国民议会之后探讨的药剂都亦然类持续性黏膜催化的制剂，因此在学时术上被认为是对乙酰氨基酚类低剂量。非游离的对乙酰氨基酚类低剂量，还包括抗抑郁药、依托度酸和萘丁美内酯，它们比其他对乙酰氨基酚类低剂量，例如舒林酸、吲哚美辛、吡罗昔康和内酯咯酸对肠道具有非常高的有效性。昔纳阿司匹林是游离一个亚胺化蛋白－2类似物。在规格剂量下，扑热息痛不是对乙酰氨基酚类低剂量。澳大利亚大肠病学时会国家科委由大肠病学时、风湿病学时、心脏病学时和内科学知识时护理人员组成，他们在小组探讨后，以这两项科研份文件为基础订定了这个解决方案。澳大利亚大肠病学时会由此可知幕的“关于对乙酰氨基酚类低剂量的运用于的国民议会”由TAP药品公司备有的一项无限教育基金资助。参加者的国库花销定为相关联在手稿内，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.校对：bluelove 校对： Zhu