https://scholars.lib.ntu.edu.tw/handle/123456789/517189
標題: | The efficacy and safety of proton pump inhibitors vs histamine-2 receptor antagonists for stress ulcer bleeding prophylaxis among critical care Patients: A meta-analysis | 作者: | Lin P.-C. CHIA-HSUIN CHANG Hsu P.-I. Tseng P.-L. Huang Y.-B. |
公開日期: | 2010 | 出版社: | Lippincott Williams and Wilkins | 卷: | 38 | 期: | 4 | 起(迄)頁: | 1197-1205 | 來源出版物: | Critical Care Medicine | 摘要: | Objective: To examine the efficacy and safety of proton pump inhibitors in comparison with histamine-2 receptor antagonists for stress-related upper gastrointestinal bleeding prophylaxis among critical care patients. DATA SOURCES: PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov. STUDY SELECTION: Randomized, controlled trials that directly compare proton pump inhibitors with histamine-2 receptor antagonists in prevention of stress-related upper gastrointestinal bleeding in intensive care unit patients published before May 30, 2008. DATA EXTRACTION: Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. The primary outcome was the incidence of stress-related upper gastrointestinal bleeding, and the secondary outcome measures were the incidence of pneumonia and intensive care unit mortality. DATA SYNTHESIS: The random effect model was used to estimate the pooled risk difference between two treatment arms irrespective of drug, dosage, and route of administration. Results: We identified seven randomized, controlled trials with a total of 936 patients for planned comparison. The overall pooled risk difference (95% confidence interval; p value; I statistics) of stress-related upper gastrointestinal bleeding comparing proton pump inhibitors vs. histamine-2 receptor antagonists was-0.04 (95% confidence interval,-0.09-0.01; p =.08; I = 66%). In the sensitivity analysis, removing the Levy study significantly reduced the heterogeneity (from I = 66% to I = 26%) and shifted the overall risk difference closer to the null (pooled risk difference,-0.02; 95% confidence interval,-0.05-0.01; p =.19). There was no difference between proton pump inhibitors and histamine-2 receptor antagonists therapy in the risk of pneumonia and intensive care unit mortality, with pooled risk differences of 0.00 (95% confidence interval,-0.04-0.05; p =.86; I = 0%) and 0.02 (95% confidence interval,-0.04-0.08; p =.50; I = 0%), respectively. Conclusions: This meta-analysis did not find strong evidence that proton pump inhibitors were different from histamine-2 receptor antagonists in terms of stress-related upper gastrointestinal bleeding prophylaxis, pneumonia, and mortality among patients admitted to intensive care units. Because of limited trial data, future well-designed and powerful randomized, clinical trials are warranted. ? 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-77950294683&doi=10.1097%2fCCM.0b013e3181d69ccf&partnerID=40&md5=dbf0c0c77d129f31cd48743f9311470c https://scholars.lib.ntu.edu.tw/handle/123456789/517189 |
ISSN: | 0090-3493 | DOI: | 10.1097/CCM.0b013e3181d69ccf | SDG/關鍵字: | cimetidine; esomeprazole; famotidine; histamine H2 receptor antagonist; lansoprazole; omeprazole; pantoprazole; proton pump inhibitor; rabeprazole; ranitidine; sucralfate; article; attributable risk; clinical trial; confidence interval; drug efficacy; drug safety; human; incidence; intensive care; intensive care unit; meta analysis; mortality; outcome assessment; peptic ulcer bleeding; pneumonia; priority journal; quality control; risk assessment; risk factor; statistical significance; systematic review; treatment outcome; treatment response |
顯示於: | 醫學系 |
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