作者：郭清源，刘高，杨慕维，王蕾，白娅萍，蔡恩丽

单位：

650500云南省昆明市，云南中医药大学护理学院 通信作者：蔡恩丽，E-mail：13708482037@139.com

Units：

College of Nursing, Yunnan University of Chinese Medicine, Kunming 650500, China Corresponding author: CAI Enli, E-mail: 13708482037@139.com

关键词：

卒中相关性肺炎; 抑酸剂; 质子泵抑制剂; H2受体阻滞剂; Meta分析;

Keywords：

Stroke-associated pneumonia; Acid-suppressive medications; Proton pump inhibitors; Histamine-2receptor antagonist; Meta-analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.155

Funds：

云南省教育厅科学研究基金项目（2022J0364，2021Y469）；云南中医药大学2022年度教育科学研究课题重大项目（ZD220101）

摘要：

目的 探讨抑酸剂与卒中相关性肺炎(SAP)发生风险的关系。方法 计算机检索PubMed、Embase、Web of Science、Wiley、中国生物医学文献数据库、中国知网、万方数据知识服务平台有关抑酸剂与SAP发生风险关系的队列研究(暴露组为使用抑酸剂的脑卒中患者,非暴露组为未使用抑酸剂的脑卒中患者),检索时间自建库至2021年12月。提取纳入文献的资料,采用纽卡斯尔-渥太华量表(NOS)进行文献质量评价,并运用RevMan 5.4进行Meta分析。结果 共纳入9篇文献,总样本量为24 350例。Meta分析结果显示,暴露组患者SAP发生风险高于非暴露组[RR=2.08,95%CI(1.62,2.68),P<0.000 01]。其中中国地区、日韩地区、美国地区、出血性脑卒中、出血性脑卒中和缺血性脑卒中、随访<3年、随访3～5年、随访>5年的暴露组患者SAP发生风险均高于非暴露组(P<0.05)。使用质子泵抑制剂(PPI)的暴露组SAP发生风险高于非暴露组[RR=1.96,95%CI(1.56,2.46),P<0.000 01],其中使用奥美拉唑、泮托拉唑/兰索拉唑、埃索美拉唑/雷贝拉唑的暴露组SAP发生风险高于非暴露组(P<0.05)。使用H2受体阻滞剂(H2RA)的暴露组SAP发生风险高于非暴露组[RR=2.07,95%CI(1.46,2.94),P<0.000 1],其中使用法莫替丁的暴露组SAP发生风险高于非暴露组(P<0.05)。结论 现有证据表明,使用抑酸剂会增加脑卒中患者SAP的发生风险,PPI及H2RA中的法莫替丁均可导致SAP发生风险增加,但上述结论仍有待更多高质量研究进一步验证。

Abstract：

【Abstract】 Objective To discuss the relationship between acid-suppressive medications and the risk of strokeassociated pneumonia (SAP) . Methods Databases including PubMed, Embase, Web of Science, Wiley, CBM, CNKI, WanFangData from inception to December 2021 were retrieved to search for cohort studies on the relationship between acid-suppressivemedications and SAP (the exposure group was stroke patients who used acid-suppressive medications, and the non-exposedgroup was stroke patients who did not use them) . The data of the included literature were extracted, the Newcastle-Ottawa Scale(NOS) was used to evaluate the quality of the included literature, and RevMan 5.4 was used for meta-analysis. Results A totalof 9 articles were included, and involving 24 350 patients. The results of meta-analysis showed that, the risk of SAP in exposedgroup was higher than that in non-exposed group [RR=2.08, 95%CI (1.62, 2.68) , P < 0.000 01] . Among them, the risk of SAP inexposed group that in China, Japan and South Korea, the United States, and with hemorrhagic stroke, hemorrhagic and ischemicstroke, and follow-up time< 3 years, follow-up time of 3-5 years, follow-up time> 5 years was higher than that in non-exposedgroup (P < 0.05) . The risk of SAP in exposed group that used proton pump inhibitor (PPI) was higher than that in non-exposedgroup [RR=1.96, 95%CI (1.56, 2.46) , P < 0.000 01] , and among them, the risk of SAP in exposed group that used omeprazole,pantoprazole/lansoprazole, esomeprazole/rabeprazole was higher than that in the non-exposed group (P < 0.05) . The risk of SAPin exposed group that used histamine-2 receptor antagonist (H2RA) was higher than that in non-exposed group [RR=2.07, 95%CI(1.46, 2.94) , P < 0.000 1] , and among them, the risk of SAP in exposed group that used famotidine was higher than that in nonexposed group (P < 0.05) . Conclusion The existing evidence shows that the use of acid-suppressive medications increases therisk of SAP in stroke patients, and both PPI and famotidine in H2RA can increase the risk of SAP, but the above conclusions stillneed to be further verified by more high-quality studies.

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