吲哚类萘的技术的发展特别是在高发呼吸道并发症项目组合意制定推荐设计方案来减小几率据加拿大大肠病研读会听取的管理研读项目组介绍，吲哚类萘给有适应症的病患缺少了广阔的效用，但是护理管理工作在给病患后下据这吗啡同一时间，须要仔细考虑它的特别是在几率。呼吸道并发症是使用非类萘的最常见的不良反应，都有上消化道和下消化道的并发症。严重影响的呼吸道并发症，如潜在的致命性细菌性病变，年再次发生率为使用者的1－4％。项目组的讨论结果“关于制定吲哚类萘都有亚胺化酶－2持续性剂和高血压的技术的发展设计方案讨论会的认同”撰写在加拿大大肠病研读会出版的9月末的《普及病研读大肠病研读与血液病研读》杂志上。“吲哚类萘是世界技术的发展最相当多的药品，而且相当多的技术的发展证实了它的功效和比较安全性” 据阿拉巴马大研读伯明翰所学院内科研读教授，论文的主要写作者C. Mel WilcoxDr介绍。“但是，从前虽然充分认识了呼吸道并发症，而并未坚信其心脏致命，加拿大大肠病研读会听取一致同意来增大对技术的发展该吗啡的效用和呼吸道及全身性毒性的几率，从而改进对该吗啡的技术的发展。”估计世界每年消耗500亿高血压片，其中加拿大有约6000万份本品后下据了高血压，并主要给老年病患。这吗啡对见、慢性疼痛和软骨关节水肿等方面有效率。但是，吲哚类萘的使用特别是在着严重影响的致命，都有呼吸道、肾脏和全身性并发症，甚至都有心力衰竭和心肌梗死。“我们欣喜地看到吲哚类萘的呼吸道并发症和幸存者早就从1992年后下始降较高，我们认为这种状况归功于一下方面：小副作用使用吲哚类萘；降较高了大肠百日咳的普及；增大了质子泵持续性剂的技术的发展；以及引进对呼吸道更加安全的吲哚类萘的技术的发展，如昔桑吗啡。” WilcoxDr说。“但是，护理管理工作和病患须要了解该吗啡的相关几率来制定吲哚类萘的最佳技术的发展设计方案。项目组为护理管理工作制定了当他们在要求是不是给病患后下吲哚类萘时的以下提议：评价病患的适应症和病患再次发生呼吸道和全身性并发症的潜在致命生物体，并和病患讨论全身性疾病的潜在致命生物体。对几率和效用展开分析来衡量个体呼吸道和全身性致命后，后下据较高几率的药品。呼吸道并发症再次发生致命大的病患须要技术的发展呼吸道几率较高的吲哚类萘，例如非软性吲哚类萘；全身性事件再次发生几率大的病患须要给予亚胺酶－2持续性剂病患；有已知全身性疾病或病理研读几率的病患须要给予小副作用高血压。限制所后下吲哚类萘的持续时间和副作用，以及拟定并提议病患展开吲哚类萘的联合病患。在技术的发展吲哚类萘病患同一时间，必先处理大肠百日咳的感染，以致不增大并发消化性病变的几率。针对呼吸道并发症几率大的病患制定大肠保护设计方案，如技术的发展米索同一时间列醇或质子泵持续性剂。“吲哚类萘的技术的发展特别是在较高呼吸道并发症在诊断和病患上很不可忽视，” WilcoxDr阐释说。“更加好地理解较高呼吸道并发症再次发生的几率和特异性是增加吲哚类萘的使用致命所须要的。”在一致同意同一时间夕讨论的药剂都是非类持续性水肿反应的药品，因此在研读术上被认为是吲哚类萘。非软性的吲哚类萘，都有桑洛芬、依托度酸和萘丁美酮，它们比其他吲哚类萘，例如舒林酸、吲哚美辛、吡罗昔康和酮咯酸对呼吸道较强更加高的安全性。昔桑吗啡是软性亚胺化酶－2抑制剂。在标准副作用下，扑热息痛不是吲哚类萘。加拿大大肠病研读会项目组由大肠病研读、风湿病研读、心脏病研读和内科研读医师都由，他们在小组讨论后，以当同一时间科研报告为基础制定了这个设计方案。加拿大大肠病研读会举办的“关于吲哚类萘的技术的发展的一致同意”由TAP药品公司缺少的一项无限教育基金资助。与会者的财政后下销定为包含在原稿内，在www.cghjournal.org. Nonsteroidal anti-inflammatory drugs use associated with higher gastrointestinal complications Consensus panel develops recommendations to minimize risks Nonsteroidal anti-inflammatory drugs (NSAIDs) provide a broad range of benefits for patients who require their use, but health care providers need to carefully consider the associated risks before prescribing these drugs for their patients, according to a multi-disciplinary panel of experts convened by the AGA Institute. Gastrointestinal (GI) morbidities are the most common adverse events associated with NSAID use, including complications in both the upper- and lower-GI tracts; serious GI complications, such as potentially fatal bleeding ulcers, occur in one to four percent of NSAID users annually. The findings of the panel, "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents, Including Cyclooxygenase-2 Enzyme Inhibitors and Aspirin," were published in the September issue of Clinical Gastroenterology and Hepatology, published by the American Gastroenterological Association (AGA) Institute. "NSAIDs are the most widely used medications in the world, and the broad use of these drugs confirms their effectiveness and relative safety," according to C. Mel Wilcox, MD, professor of medicine, University of Alabama at Birmingham, and lead author of the paper. "However, well-recognized GI complications and previously unrecognized cardiac risks he caused great concern about the use of these drugs among healthcare professionals. The AGA Institute convened the consensus conference to increase awareness about the benefits and the risks of GI and cardiovascular toxicities associated with these medications and to improve their use." An estimated 50 billion aspirin tablets are consumed worldwide and approximately 60 million prescriptions are written for NSAIDs each year in the U.S., predominantly for older patients. These drugs are effective in acute and chronic treatment of painful and inflammatory musculoskeletal conditions, among others. However, NSAID use is associated with several risks including GI, renal and cardiovascular complications, including heart failure and myocardial infarction. "We were pleased to note that both NSAID-associated GI complications and death he been decreasing since 1992, which we believe can be attributed to several factors: use of lower-dose NSAIDs; decreasing prevalence of H. pylori; increasing use of proton-pump inhibitors; and the introduction of NSAIDs with greater GI safety, such as coxibs," said Dr. Wilcox. "However, healthcare providers and patients need to be aware of the risks associated with these drugs to develop the best plan for using NSAID therapy." The panel developed the following recommendations for healthcare providers to use when determining whether to prescribe NSAID treatment to their patients:
◎Review the treatment indication and potential patient risk factors, both for GI and cardiovascular complications, and discuss potential cardiovascular risk factor modifications with their patients. ◎Prescribe lower-risk agents after conducting a risk-benefit ysis to determine the GI versus cardiovascular risks for each individual. Patients who are at greater risk of GI bleeding should receive NSAIDs with lower GI risks, such as nsNSAIDs; patients with a greater risk of cardiovascular events should not receive COX-2 inhibitors; and patients with known or a high risk of cardiovascular disease should receive low-dose aspirin. ◎Limit the duration and dosage of the prescribed NSAID and ask about and advise their patients on combination NSAID therapy. ◎Treat patients with H. pylori infection prior to beginning NSAID therapy so as not to increase the risk of complicated ulcers. ◎Institute gastroprotection methods, such as misoprostol or proton pump inhibitors (PPIs), for patients at high-risk of GI complications. "The association of NSAID use with lower-GI tract complications is important diagnostically and therapeutically," explained Dr. Wilcox. "A better understanding of risk factors for and mechanisms of lower-GI tract bleeding in NSAID users will be required to address risk reduction." All agents discussed during the consensus conference were nonsteroidal, inhibit inflammation, and thus are technically considered NSAIDs. Nonselective NSAIDs include ibuprofen, etodolac and nabumetone, which may he superior GI safety than other nsNSAIDs, such as sulindac, indomethacin, piroxicam and ketorolac. Coxibs are selective NSAIDs. In standard doses, acetaminophen is not an NSAID. The AGA Institute panel was comprised of physicians in gastroenterology, rheumatology, cardiology and internal medicine who developed the statement based on presentations of current scientific knowledge followed by group discussion. The AGA Institute "Consensus Development Conference on the Use of Nonsteroidal Anti-Inflammatory Agents" was supported though an unrestricted educational grant from TAP Pharmaceutical Products Inc. Financial disclosures for conference participants are included in the manuscript at www.cghjournal.org.撰稿人：bluelove 撰稿人： Zhu
