Application of proton pump inhibitor to prevent stress ulcer

Stress ulcer (stress ulcer, SU) common to all types of severe trauma, acute gastrointestinal mucosal erosion occurs under stress in critical illness or serious mental diseases, ulcers and other diseases, severe cases can be complicated by digestive tract bleeding, and even Perforation can aggravate and worsen the pre-existing disease and increase the mortality rate.

Digestion prevention

Inhibiting gastric acid and increasing the pH value of the stomach have an important effect on SU.

The purpose of preventive use of PPIs : to prevent acute gastric mucosal lesions .

The purpose of preventive use of PPIs : to prevent acute gastric mucosal lesions .

Recommended standard dose:

Indications for use

Indications for use Indications for use

(1) Which patients need to use

(1) Which patients need to use

Patients receiving mechanical ventilation, those with a high risk of bleeding (including those who are expected to have mechanical ventilation ≥48h or have abnormal coagulation function, etc.

(2) Contains the following factors + ICU patients also need to use

(2) Contains the following factors + ICU patients also need to use +

(1) Severe trauma {including multiple injuries, ISS score (traumatic severity score) ≥ 16 points};

(2) Acute renal failure;

(3) Acute liver failure;

(4) Acute lung injury;

(5) Children with respiratory failure or coagulation dysfunction or child death risk score ≥10;

child

(3) Patients with two or more of the following risk factors can also use PPI

(3) Patients with two or more of the following risk factors can also use PPI

(1) Sepsis

(2) ICU hospital stay ≥ 7 days

(3) Occult blood nourishment ≥ 6 days

(4) Use high-dose glucocorticoids (hydrocortisone> 250 mg/d or equivalent doses of other glucocorticoids)

(4) The following high-risk factors + severe psychological stress can be used

(4) The following high-risk factors + severe psychological stress can be used +

(1) After organ transplantation;

(2) a year digestive ulcer or upper gastrointestinal bleeding history;

Digestion

(3) Blood coagulation dysfunction (PLT<50×109/L, INR>1.

(4) Severe jaundice;

(5) Age> 65 years old;

(6) Long-term use of immunosuppressive agents;

immunity

(7) Need to rely on parenteral nutrition supplementation after fasting;

(8) After radiofrequency ablation or chemoembolization for liver cancer, stomach cancer , and pancreatic cancer ;

Gastric cancer pancreatic cancer

(9) After ERCP (endoscopic retrograde cholangiopancreatography);

(10) Increased gastrin

Mode of administration

Mode of administration Mode of administration

For high-risk groups , the conventional dose is sufficient for prevention of SU , while for patients who can not be administered orally , intravenous medication may be considered .

Prevent conventional doses of SU from oral and intravenous medications

Preoperative preventive medication can be administered within the day before surgery.

Recommended for patients with short-course intravenous administration

Recommended for patients with short-course intravenous administration

(1) Patients with tumors use intravenous chemotherapy drugs that may cause vomiting;

(2) Severe head injury, cervical spinal cord injury, GCS score ( Glasgow coma score) ≤ 10 points (or unable to execute simple commands);

Glasgow coma

(3) Adults with burn area> 30%, and children with burns aged ≥ 1 month;

(4) Before various difficult and complicated major operations (the expected operation time is not less than 4 hours), such as partial liver resection and pancreatic cancer resection;

(5) Multiple organ dysfunction syndrome or multiple organ failure;

(6) After heart, lung, and brain resuscitation;

(7) Combined shock or persistent hypotension;

(8) Acute respiratory distress syndrome;

(9) cardio-cerebral vascular accidents;

Blood vessel

(10) Intestinal obstruction;

(11) Those with a history of upper gastrointestinal bleeding, before undergoing gastrointestinal endoscopy

Some notes

Some precautions some precautions

Oral drugs

Oral drugs

Precautions for oral drugs: Do not chew or crush, and take it at least 1 hour before a meal; avoid the same use with acid drugs

Intravenous administration

Intravenous administration

It is appropriate to use 0.

Stop medication indication

Stop medication indication

The course of preventive medication is limited to patients who stop mechanical ventilation, can tolerate enteral nutrition, clinical symptoms begin to improve, clinical bleeding risk is reduced, or transferred to the intensive care unit, but for patients with high secretion of gastric acid (such as head surgery, severe burns, etc.

Long-term medications that are not sufficient and necessary must be avoided

 

Medications for special populations

Medications for special populations Medications for special populations

How to use in the elderly?

How to use in the elderly?

The pharmacokinetics of PPIs in the elderly, patients with renal insufficiency, and patients with mild to moderate hepatic insufficiency are similar to that of young people, so there is no need to adjust the dose ; but for patients with severe hepatic insufficiency, the maximum area under the curve is 2～2 of those with normal liver function.

Therefore, there is no need to adjust the dose in the elderly, the incidence is slightly higher

 

Principles of medication: (1) Do not exceed the indications for medication (2) Generally use standard doses for prevention

Medication principles: (1) Medication principles: (1) Do not exceed the indications for medication (2) (2) Generally use standard dose prevention

The elderly should prefer PPIs that have less interaction with other commonly used drugs, such as pantoprazole and rabeprazole

How to use in children?

How to use in children?

   For the prevention of SU in children with severe trauma and high-risk factors, standard-dose PPIs can be injected intravenously or instilled after the onset of the disease, which can be administered once every 12 hours or once every 8 hours.
Use 2 to 3 days until the high-risk factors are removed After that, sequential oral treatment was continued until the end of the course of treatment
.
The selection and dosage adjustment of PPIs need to consider the influence and degree of the metabolism and excretion of the drug in the body when liver and kidney function decline
.

Injection : It is often used for high-risk children who have high-risk factors such as upper gastrointestinal bleeding, SU , or fasting, dysphagia, etc.
who are not suitable for oral administration
.

IDUs IDUs : commonly used in the upper gastrointestinal bleeding, the SU children at high risk for oral administration should not be high-risk factors or fasting, swallowing difficulties
.

Discontinuation indications

Indications for discontinuation

Severe emergency patients may consider discontinuing PPIs after their condition is stable, their clinical symptoms improve, they start eating, can tolerate enteral nutrition, or are transferred from the Pediatric Intensive Care Unit (PICU) to the general ward
.
Depending on the severity of the disease, the course of treatment can be extended for 7-10 days or even 2 weeks
.

Severe emergency patients may consider discontinuing PPIs after their condition is stable, their clinical symptoms improve, they start eating, can tolerate enteral nutrition, or are transferred from the Pediatric Intensive Care Unit (PICU) to the general ward
.
Depending on the severity of the disease, the course of treatment can be extended for 7-10 days or even 2 weeks
.

 

 

Adverse reaction treatment

Adverse reaction treatment

The drug can be discontinued for observation, or replaced with an H ₂  receptor antagonist
.

₂

 

references

references

[1] Expert consensus writing group on the preventive application of proton pump inhibitors.
Expert consensus on the preventive application of proton pump inhibitors (2018)[J].
Chinese Physician Journal, 2018, 20(12): 1775-1781.

consensus

[2]Zheng Songbai, Yao Jianfeng.
Expert consensus on the rational application of proton pump inhibitors in the elderly[J].
Chinese Electronic Journal of Geriatric Research, 2015, 2(04):1-7.

[3] Wang Gang, Li Zailing, Xie Xiaoli, Xu Donghang.
Expert consensus on the rational use of proton pump inhibitors in children (2019 edition) [J].
Chinese Journal of Practical Pediatrics, 2019, 34(12): 977-981.

Leave a message here