药物不良反应发生率 质子泵抑制剂在老年心血管病中的应用(3)

目前，国内尚无较大规模高质量的临床研究来探讨PPIs相关的不良反应。药物不良反应发生率在临床实践中，PPIs是一把双刃剑，关键在于如何应用，规范使用可以治病，滥用则可能致病。因此，临床医生应严格掌握好PPIs的适应证，特别是对于老年人，更应该规范使用PPIs，尽量避免长期大剂量应用PPIs可能带来的心血管风险。

参考文献

[1]HamonM, LemesleG, TricotO, et al.Incidence, source, determinants, and prognostic impact of major bleeding in outpatients with stable coronary artery disease[J]. Am Coll Cardiol, 2014, 64(14): 1430-1436.DOI: 10.1016/j.jacc.2014.07.957.

[2]KoskinasKC, R??berL, ZanchinT, et al.Clinical impact of gastrointestinal bleeding in patients undergoing percutaneous coronary interventions[J]. Circ Cardiovasc Interv, 2015, 8(5). Pii: e002053.DOI: 10.1161/CIRCINTERVENTIONS.114.002053.

[3]BhattDL, CryerBL, ContantCF, et al.Clopidogrel with or without omeprazole in coronary artery disease[J]. N Engl J Med, 2010, 363: 1909-1917.DOI: 10.1056/NEJMoa1007964.

[4]CharlotM, GroveEL, HansenPR, et al.Proton pump inhibitor use and risk of adverse cardiovascular events in aspirin treated patients with first time myocardial infarction: nationwide propensity score matched study[J]. BMJ, 2011, 342: d2690.DOI: 10.1136/bmj.d2690.

[5]CardosoRN, BenjoAM, DiNicolantonioJJ, et al.Incidence of cardiovascular events and gastrointestinal bleeding in patients receiving clopidogrel with and without proton pump inhibitors: an updated meta-analysis[J]. Open Heart, 2015, 2(1): e000248.DOI: 10.1136/openhrt-2015-000248.

[6]抗血小板药物消化道损伤的预防和治疗中国专家共识组．抗血小板药物消化道损伤的预防和治疗中国专家共识(2012更新版)[J]．中华内科杂志，2013，52(3): 264-270.DOI：10.3760/cma.j.issn.0578-1426.2013.03.027.

[7]抗栓治疗消化道损伤防治专家组．抗栓治疗消化道损伤防治中国专家建议(2016·北京)[J]．中华内科杂志，2016，55(7): 564-567.DOI：10.3760/cma.j.issn.0578-1426.2016.07.020.