How to use proton pump inhibitors to prevent stress ulcers?

It is only for medical professionals to read for reference.
Which stress ulcers can be used preventively with PPI? How to choose drugs? Proton pump inhibitors (PPI) are gastric acid secretion inhibitors, such as omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole, etc.
, which can be specifically and non-competitively Acting on H+/K+-ATPase, it can strongly inhibit acid, with fast onset, complete acid suppression, and long-lasting acid suppression.
It can be clinically used to prevent stress ulcers
.

Stress ulcer (SU), also known as stress mucosal disease (SRMD), acute gastric mucosal disease, acute erosive gastritis, and acute hemorrhagic gastritis, is the body's response to various types of severe trauma, critical illness or severe mental illness.
In the irritated state, acute gastrointestinal mucosal erosions, ulcers and other diseases may occur.
In severe cases, gastrointestinal bleeding or even perforation may occur, and the degree of the original disease may be aggravated and worsened
.

Then, which stress ulcers can be used for preventive use of PPI, how to choose the drug, and what should be paid attention to when using it? Get to know it together
.

An indication of proton pump inhibitors for the prevention of stress ulcers PPI prevention of critically ill SU is only suitable for high-risk populations, and the goal of prevention is to control the pH ≥ 4 in the stomach
.

"Expert Recommendations on the Prevention and Treatment of Stress Ulcer" (2015 Edition)" / "Expert Recommendations on the Prevention and Treatment of Stress Ulcer (2018 Edition)", "Expert Consensus on the Preventive Application of Proton Pump Inhibitors (2018)", "Proton Pump Inhibition in Hunan Province" Guidelines for the Clinical Application of Proton Pump Inhibitors (Trial) (2016)", "Guidelines for the Clinical Application of Proton Pump Inhibitors (2020 Edition)", "Expert Consensus on the Rational Use of Proton Pump Inhibitors in Children (2019 Edition)", "Proton Pump Inhibition Expert Consensus on Drug Optimization Application (2020), "Expert Guidance Opinions on Preventive Use of Proton Pump Inhibitors and Prescription Simplification (Guangdong Pharmaceutical Association July 1, 2019)" all introduce the indications of PPI for the prevention of SU
.

Table 1: Expert opinions on the prevention and treatment of stress ulcers (2015 edition)/Expert opinions on the prevention and treatment of stress ulcers (2018 edition) Table 2: Expert consensus on the preventive application of proton pump inhibitors (2018) Table 3: Proton pump inhibitors in Hunan Province Guiding Principles for Clinical Application (Trial) (2016) Table 3: Indications of PPI to Prevent SU "Guiding Principles for Clinical Application of Proton Pump Inhibitors (2020 Edition)" Table 4: SU Risk Factors and Preventive Medication Recommendations "Children's Proton Pump Inhibition Expert Consensus on the Reasonable Use of Drugs (2019 Edition) Table 5: SU Risk Factors and Preventive Medication Recommendations "Expert Consensus on Optimal Application of Proton Pump Inhibitors (2020)" Table 6: SU Risk Factors and Preventive Recommendations "Preventive Use of Proton Pump Inhibition Expert guidance on simplification of medicines and prescriptions (Guangdong Pharmaceutical Association July 1, 2019)" In addition, the risk of SU should also be comprehensively evaluated for non-severe patients, and preventive measures should be taken if necessary
.

The "Guiding Principles for the Clinical Application of Proton Pump Inhibitors in Hunan Province (Trial)" (2016) pointed out that if preventive measures are not taken, the incidence of bleeding can reach 1.
16% for high-risk individuals, and even more than 3.
24% for high-risk individuals.
If preventive measures are taken, the incidence of bleeding can be reduced by at least half
.

Table 7: The clinical risk scoring system for gastrointestinal bleeding caused by SU in non-severe patients "Expert Consensus on Optimal Application of Proton Pump Inhibitors (2020)" The choice of two proton pump inhibitors for the prevention of stress ulcers is more antagonistic than H2 receptors H2RA can continuously and steadily increase the pH of the stomach, and reduce the risk of bleeding related to SU, which is significantly better than H2RA.
It is the first choice for the prevention of SU
.

Table 8: PPI used for SU selection PPI to prevent SU withdrawal indications: SU high-risk groups, after the occurrence of risk factors, intravenous injection or instillation of conventional doses of PPI, the course of treatment is generally 3-7 days, when mechanical ventilation is stopped, clinical bleeding After the risk is reduced, the condition is stable, enough enteral nutrition can be tolerated, or the food has been taken, the clinical symptoms begin to improve, or the drug can be changed to oral administration or gradually stopped after being transferred to the general ward
.

However, for patients with high acid secretion (such as head surgery, severe burns), it is recommended to stop the drug until the oral intake can meet the required nutrients
.

According to the "Expert Consensus on the Rational Use of Children's Proton Pump Inhibitors (2019 Edition)" (2019), the course of treatment can be extended by 7-10 days or even 2 weeks depending on the severity of the disease
.

Precautions for the use of three proton pump inhibitors to prevent stress ulcers PPI prevention SU Strictly grasp the medication and withdrawal indications, medication should be limited to critically ill patients with high-risk factors, and avoid use for those without indications; there are indications for withdrawal Disable PPI from time to time to avoid excessive use
.

PPI oral preparations are generally enteric-coated preparations, which should be swallowed as whole tablets/tablets, and should not be chewed, crushed or dissolved
.

Esomeprazole magnesium enteric-coated tablets and omeprazole magnesium enteric-coated tablets are available in the form of MUPS (multi-unit microcapsule system), which can be dissolved in carbonate-free water, and those who are unconscious or unable to take the drug can pass through a gastric tube For administration, those with a nasogastric tube can dissolve the drug in water and inject it through a nasogastric tube
.

The PPI aqueous solution is unstable and unstable to strong acids, and is easily affected by the pH value of the solution, light, and temperature
.

PPI should not be stored for a long time after preparation.
Pay attention to the infusion time, otherwise the solution may change color; it cannot be used simultaneously or sequentially with acidic drugs.
The syringe should be used alone and should not be in contact with other liquids; the pipeline needs to be flushed when combined medication is required; In case of discoloration, turbidity, precipitation, etc.
, the infusion should be stopped immediately
.

Omeprazole freeze-dried preparations have two formulas: intravenous drip and intravenous bolus injection.
The former adds EDTA to avoid oxidative deterioration when diluted with a large amount of sodium chloride injection or glucose injection; and for intravenous bolus injection The preparation does not need to add EDTA due to the small amount of diluent and short bolus time, but it is equipped with a special solvent for the co-solvent polyethylene glycol 400 and the pH adjuster citric acid
.

Do not mix with each other in clinical use.
Intravenous injection formula is not suitable for intravenous drip, and intravenous injection formula is not suitable for intravenous injection
.

Clopidogrel is an antiplatelet drug, which can easily cause gastric mucosal damage.
Because CYP2C19 inhibitors can affect its effect, some PPIs may reduce its efficacy and increase thrombotic adverse events
.

The inhibitory strength of the five PPIs on CYP2C19 was omeprazole>esomeprazole>lansoprazole>pantoprazole>rabeprazole
.

If you are using clopidogrel, if you need to use PPI, you can consider rabeprazole or pantoprazole
.

PPI may increase the risk of adverse events such as hospital-acquired pneumonia and Clostridium difficile infection in critically ill patients, but opportunistic infections are mostly those who receive long-term antibiotic treatment or have weakened immunity.
It is necessary to pay attention to avoid long-term use of PPI
.

Reference materials: [1]Expert consensus on the preventive application of proton pump inhibitors (2018)[J].
Chinese Physician Journal,2018,20(12):1775-1778[2]Expert recommendations for the prevention and treatment of stress ulcers (2018 edition) [J].
Chinese Medical Journal, 2018, 98(42): 3392-3395 [3] Expert advice on the prevention and treatment of stress ulcers (2015 edition) [J].
Chinese Medical Journal, 2015, 95(20): 1555-1557 [4] Guiding Principles for the Clinical Application of Proton Pump Inhibitors in Hunan Province (Trial) [J].
Zhongnan Pharmaceutical, 2016, 14(7): 673-676 [5] Guiding Principles for the Clinical Application of Proton Pump Inhibitors (2020 Edition) [ J].
2020[6]Expert consensus on the optimal application of proton pump inhibitors[J].
Chinese Journal of Hospital Pharmacy,2020[7]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 [8] Expert guidance on preventive use of proton pump inhibitors and simplification of prescriptions (Guangdong Pharmaceutical Association July 1, 2019) [9] Experts on the rational use of proton pump inhibitors in the elderly Consensus[J].
Chinese Journal of Geriatrics,2015,34(10):1045-1048