Peptiskas čūlas asiņošana pacientiem ar un bez nesteroīdo pretiekaisuma līdzekļu lietošanas
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Date
2021
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Pētījuma aktualitāte. Nesteroīdie pretiekaisuma līdzekļi (NSPL) ir vieni no biežāk lietotajiem medikamentiem pasaulē, taču to lietošana ir saistīta ar paaugstinātu peptiskas čūlas rašanās un asiņošanas risku.
Darba mērķi. Izvērtēt NSPL lietošanas risku, salīdzinot divas akūti asiņojošas peptiskas čūlas pacientu grupas ar vai bez iepriekšējas NSPL terapijas. Salīdzināt akūtas peptiskas čūlas asiņošanas dēļ hospitalizēto pacientu iznākumu NSPL lietotāju un nelietotāju vidū.
Materiāls un metodes. Prospektīvs, jaukts kohortas pētījums. Tajā tika iekļauti pilngadību sasnieguši pacienti bez dzimuma ierobežojuma, kuri tika hospitalizēti RAKUS “Gaiļezers” un kuriem endoskopiski tika pierādīta akūta peptiskas čūlas asiņošana (pēc Foresta klasifikācijas no FIA līdz FIIC) laika periodā no 2019. gada aprīļa līdz 2020. gada novembrim. Pētījumā tika izmantota no pacientu intervijām un no medicīniskās dokumentācijas iegūtā informācija: pacientu vecums, dzimums, NSPL lietošanas anamnēze, čūlas asiņošanas smaguma pakāpe pēc Foresta klasifikācijas, čūlas lokalizācija, kā arī vērtēts stacionārā pavadītais dienu skaits (ietverot laiku intensīvās terapijas nodaļā (ITN)), stacionēšanas reižu skaits, pielietotā ārstēšanas metode un mirstība. Dati tika apkopoti un apstrādāti datorprogrammās MS Word, Excel un IBM SPSS 20.0.
Rezultāti. No 46 pacientiem (vidējais vecums 60 ± 17.02 gadi) pētījumā piedalījās 24 (52.2%) sievietes (vidējais vecums 67 ± 16.67 gadi) un 22 (47.8%) vīrieši (vidējais vecums 53 ± 14.6 gadi). Iepriekš NSPL bija lietojuši 22 (47.8%) pacienti (vidējais vecums 54 ± 15.9 gadi), bet 24 (52.2%) nebija (vidējais vecums 66 ± 16.28 gadi). No 22 NSPL lietotājiem, 13 (59.1%) bija sievietes (vidējais vecums 58 ± 15.62 gadi) un 9 (40.9%) vīrieši (vidējais vecums 49 ± 15.87 gadi), NSPL nelietotāju grupā sievietes bija 11 (45.8%) (vidējais vecums 78 ± 9.82 gadi) un vīrieši 13 (54.2%) (vidējais vecums 56 ± 13.61 gadi). Pacientiem ar akūtu peptiskas čūlas asiņošanu un iepriekšēju NSPL terapiju netika pierādīta statistiski ticama atšķirība čūlas asiņošanas smaguma pakāpē (pēc Foresta klasifikācijas), laika periodā, ko pacients pavadījis stacionārā (tajā skaitā ITN), stacionēšanas reižu skaitā, ķirurģiskās ārstēšanas nepieciešamības biežumā vai mirstībā, salīdzinot ar pacientiem bez iepriekš lietotas NSPL terapijas (p>0.05). Pacientiem ar iepriekšēju NSPL terapiju netika novērota statistiski ticama asociācija ar biežāk veiktu hemostātisko terapiju ar adrenalīnu, hemostātiskā aerosola pielietošanu, termokoagulācijas vai embolizācijas izmantošanu (p>0.05). Hemostāzes terapija ar klipsi statistiski ticami biežāk tika izmantota NSPL lietotāju vidū (p=0.002).
Secinājumi. NSPL lietotāji biežāk saņēma terapiju ar klipsi akūtas augšējās endoskopijas laikā. Starp abām grupām netika pierādīta atšķirība slimības iznākumā.
Objectives. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications, however NSAIDs use is associated with an increased risk of peptic ulcer disease (PUD) and acute peptic ulcer bleeding (APUB). Aims. To evaluate the risk of bleeding from peptic ulcer in patients with and without prior NSAID therapy. To compare outcomes in hospitalized patients with APUB among NSAID users and non-users. Materials and methods. Prospective, randomized cohort study of patients over 18 years of age who were consecutively hospitalized in a tertiary center in Latvia - Riga East Clinical University Hospital with APUB (according to the Forrest classification from FIA to FIIC) from April 2019 to November 2020. Data were collected from interviews and medical records: age, gender, history of NSAID use, Forrest classification, localization of ulcer, hospitalization time, admission to intensive care unit (ICU), number of hospitalizations, received treatment and mortality. Data were analyzed using MS Word, Excel and IBM SPSS 20.0. Results. From 46 patients 24 (52.2%) were females (mean age 67 ± 16.67 years) and 22 (47.8%) males (mean age 53 ± 14.6 years). Prior NSAIDs therapy received 22 (47.8%) patients (mean age 54 ± 15.9 years), but 24 (52.2%) did not (mean age 66 ± 16.28 years). From 22 NSAID users, 13 (59.1%) were females (mean age 58 ± 15.62 years) and 9 (40.9%) males (mean age 49 ± 15.87 years), but in the second group there were 11 (45.8%) females (mean age 78 ± 9.82 years) and 13 (54.2%) males (mean age 56 ± 13.61 years). Patients with APUB and prior NSAIDs therapy did not show statistically significant difference in bleeding severity according to Forrest classification, in hospitalization time (including time in ICU), in number of hospitalizations, in need for surgical treatment or mortality in a comparison with patients without prior NSAIDs therapy (p>0.05). Patients with prior NSAIDs therapy did not show statistically significant association with more often use of adrenaline, hemostatic spray, thermocoagulation or embolization (p>0.05). Statistically significant difference was found in received clips among NSAIDs users (p=0.002). Conclusions. NSAIDs users received more clips during acute endoscopy. There was no difference found regarding disease outcomes in both groups.
Objectives. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used medications, however NSAIDs use is associated with an increased risk of peptic ulcer disease (PUD) and acute peptic ulcer bleeding (APUB). Aims. To evaluate the risk of bleeding from peptic ulcer in patients with and without prior NSAID therapy. To compare outcomes in hospitalized patients with APUB among NSAID users and non-users. Materials and methods. Prospective, randomized cohort study of patients over 18 years of age who were consecutively hospitalized in a tertiary center in Latvia - Riga East Clinical University Hospital with APUB (according to the Forrest classification from FIA to FIIC) from April 2019 to November 2020. Data were collected from interviews and medical records: age, gender, history of NSAID use, Forrest classification, localization of ulcer, hospitalization time, admission to intensive care unit (ICU), number of hospitalizations, received treatment and mortality. Data were analyzed using MS Word, Excel and IBM SPSS 20.0. Results. From 46 patients 24 (52.2%) were females (mean age 67 ± 16.67 years) and 22 (47.8%) males (mean age 53 ± 14.6 years). Prior NSAIDs therapy received 22 (47.8%) patients (mean age 54 ± 15.9 years), but 24 (52.2%) did not (mean age 66 ± 16.28 years). From 22 NSAID users, 13 (59.1%) were females (mean age 58 ± 15.62 years) and 9 (40.9%) males (mean age 49 ± 15.87 years), but in the second group there were 11 (45.8%) females (mean age 78 ± 9.82 years) and 13 (54.2%) males (mean age 56 ± 13.61 years). Patients with APUB and prior NSAIDs therapy did not show statistically significant difference in bleeding severity according to Forrest classification, in hospitalization time (including time in ICU), in number of hospitalizations, in need for surgical treatment or mortality in a comparison with patients without prior NSAIDs therapy (p>0.05). Patients with prior NSAIDs therapy did not show statistically significant association with more often use of adrenaline, hemostatic spray, thermocoagulation or embolization (p>0.05). Statistically significant difference was found in received clips among NSAIDs users (p=0.002). Conclusions. NSAIDs users received more clips during acute endoscopy. There was no difference found regarding disease outcomes in both groups.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
NSPL, peptiskas čūlas asiņošana, akūta gastrointestināla asiņošana., NSAID, peptic ulcer bleeding, acute gastrointestinal bleeding.