Baidu
map

消化

订阅

MedSci主页 / 所有栏目 / 消化

服用阿司匹林易致胃肠道出血，该如何应对？

2022-06-12 beartwo MedSci原创

阿司匹林胃肠道出血
关注

如何利用这把“双刃剑”。

随着人口老龄化以及心血管疾病的负担加重，阿司匹林的应用已经较为广泛。作为预防心脑血管疾病的常用药物，其胃损伤作用一直是临床绕不开的话题。今天就和大家一起讨论学习一下阿司匹林的胃粘膜损伤问题。
一、阿司匹林引起胃粘膜损伤的机制
1、局部作用：阿司匹林药品本身呈酸性，长期使用可以对胃粘膜引起损伤；
2、全身作用：阿司匹林属于非甾体类抗炎药物，通过抑制环氧合酶（COX-1）活性，减少前列腺素PGs的合成，引起胃粘膜血流量减少，减少粘液及碳酸氢盐的分泌，使粘膜防御能力降低，进而出现胃糜烂、溃疡等症。
二、阿司匹林胃粘膜损伤的预防、治疗策略
1、使用之前，充分权衡获益风险
如果计划长期服用阿司匹林，在使用之前必须对患者基础情况进行评估，评估包括两个方面：
(1)评估阿司匹林使用的必要性。
即患者的心脑血管病情是否需要确需使用；有研究表明：对心血管危险水平较低的人群，阿司匹林心血管疾病的一级预防不能获益反而胃肠道微出血事件风险升高。
(2)评估患者的胃肠道出血风险。
在使用阿司匹林之前，建议询问消化系统症状、病史。高龄、既往消化道溃疡病史、肾小球滤过率低是阿司匹林服用后胃粘膜损伤出血的高危因素，必要时行相关检查。
2、根除幽门螺杆菌
有研究表明，幽门螺杆菌和非甾体类药物是独立的、增加胃溃疡风险的因素。患者同时拥有这两个因素，即感染HP的患者，较一般患者，服用非甾体类药物出现消化道溃疡的风险更高。因此建议在服用之前，检查幽门螺杆菌，行根治治疗。
3、小剂量维持
由于阿司匹林的胃肠道反应呈剂量依赖性，因此在必须应用的前提下，可尽可能的降低剂量。
4、阿司匹林胃粘膜损伤预防治疗用药
如果确需使用，则在使用阿司匹林的同时即开始采取必要的措施预防胃粘膜损伤。
1、胃保护药
1）米索前列醇
本药为PG类似物，可以补充阿司匹林引起的PGs合成减少，预防阿司匹林引起的胃粘膜损伤。
2、胃粘膜保护剂
1）硫糖铝
本药可以在胃粘膜表面形成覆膜，减少胃粘膜上皮细胞的暴露，对胃粘膜起保护作用。
2）抑酸药
质子泵抑制剂和组胺H2受体拮抗剂，通过抑制胃酸分泌以及清除自由基来保护胃粘膜。
有研究表明，PPI可以显著降低双抗治疗（阿司匹林+氯吡格雷）引起胃肠道出血事件风险。
预防NSAIDs所致的上消化道并发症的国内和国际指南一致推荐使用PPIs。
尽管组胺H2受体拮抗剂对NSAIDs所致胃溃疡有帮助，但是对胃出血改善意义不大，因此不推荐。
参考文献：
赵辽辽,陈晶,杜雅菊.阿司匹林及氯比格雷相关胃损伤治疗新进展[J].胃肠病学和肝病学杂志,2016,25(04):461-464.

版权声明：
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料，版权均属于梅斯医学所有。非经授权，任何媒体、网站或个人不得转载，授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章，或“梅斯号”自媒体发布的文章，仅系出于传递更多信息之目的，本站仅负责审核内容合规，其内容不代表本站立场，本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系，我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1778551, encodeId=1b411e785517b, content=看来用之前查下HP是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7da05593338, createdName=ms4000001530839250, createdTime=Sun Sep 18 09:49:37 CST 2022, time=2022-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1239249, encodeId=7cef1239249df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=99206163724, createdName=ms9000000236829232, createdTime=Wed Aug 17 11:32:13 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236559, encodeId=5f6f12365592c, content=心、脑血管科医护人员应该学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ab606579033, createdName=ms8000001408294061, createdTime=Thu Aug 04 12:27:24 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346383, encodeId=fa6c134638333, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390991, encodeId=f8e1139099140, content=<a href='/topic/show?id=6e618332871' target=_blank style='color:#2F92EE;'>#胃肠道出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83328, encryptionId=6e618332871, topicName=胃肠道出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b6a2500070, createdName=124987a0m66(暂无昵称), createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=)]
    2022-09-18 ms4000001530839250

    看来用之前查下HP是有用的

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1778551, encodeId=1b411e785517b, content=看来用之前查下HP是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7da05593338, createdName=ms4000001530839250, createdTime=Sun Sep 18 09:49:37 CST 2022, time=2022-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1239249, encodeId=7cef1239249df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=99206163724, createdName=ms9000000236829232, createdTime=Wed Aug 17 11:32:13 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236559, encodeId=5f6f12365592c, content=心、脑血管科医护人员应该学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ab606579033, createdName=ms8000001408294061, createdTime=Thu Aug 04 12:27:24 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346383, encodeId=fa6c134638333, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390991, encodeId=f8e1139099140, content=<a href='/topic/show?id=6e618332871' target=_blank style='color:#2F92EE;'>#胃肠道出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83328, encryptionId=6e618332871, topicName=胃肠道出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b6a2500070, createdName=124987a0m66(暂无昵称), createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=)]
    2022-08-17 ms9000000236829232

    学习了

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1778551, encodeId=1b411e785517b, content=看来用之前查下HP是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7da05593338, createdName=ms4000001530839250, createdTime=Sun Sep 18 09:49:37 CST 2022, time=2022-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1239249, encodeId=7cef1239249df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=99206163724, createdName=ms9000000236829232, createdTime=Wed Aug 17 11:32:13 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236559, encodeId=5f6f12365592c, content=心、脑血管科医护人员应该学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ab606579033, createdName=ms8000001408294061, createdTime=Thu Aug 04 12:27:24 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346383, encodeId=fa6c134638333, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390991, encodeId=f8e1139099140, content=<a href='/topic/show?id=6e618332871' target=_blank style='color:#2F92EE;'>#胃肠道出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83328, encryptionId=6e618332871, topicName=胃肠道出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b6a2500070, createdName=124987a0m66(暂无昵称), createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=)]
    2022-08-04 ms8000001408294061

    心、脑血管科医护人员应该学习

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1778551, encodeId=1b411e785517b, content=看来用之前查下HP是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7da05593338, createdName=ms4000001530839250, createdTime=Sun Sep 18 09:49:37 CST 2022, time=2022-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1239249, encodeId=7cef1239249df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=99206163724, createdName=ms9000000236829232, createdTime=Wed Aug 17 11:32:13 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236559, encodeId=5f6f12365592c, content=心、脑血管科医护人员应该学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ab606579033, createdName=ms8000001408294061, createdTime=Thu Aug 04 12:27:24 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346383, encodeId=fa6c134638333, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390991, encodeId=f8e1139099140, content=<a href='/topic/show?id=6e618332871' target=_blank style='color:#2F92EE;'>#胃肠道出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83328, encryptionId=6e618332871, topicName=胃肠道出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b6a2500070, createdName=124987a0m66(暂无昵称), createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=)]
    2022-06-14 liao1619

    #胃肠道#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1778551, encodeId=1b411e785517b, content=看来用之前查下HP是有用的, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7da05593338, createdName=ms4000001530839250, createdTime=Sun Sep 18 09:49:37 CST 2022, time=2022-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1239249, encodeId=7cef1239249df, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=99206163724, createdName=ms9000000236829232, createdTime=Wed Aug 17 11:32:13 CST 2022, time=2022-08-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1236559, encodeId=5f6f12365592c, content=心、脑血管科医护人员应该学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=75, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ab606579033, createdName=ms8000001408294061, createdTime=Thu Aug 04 12:27:24 CST 2022, time=2022-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1346383, encodeId=fa6c134638333, content=<a href='/topic/show?id=339e8332035' target=_blank style='color:#2F92EE;'>#胃肠道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83320, encryptionId=339e8332035, topicName=胃肠道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e03212, createdName=liao1619, createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1390991, encodeId=f8e1139099140, content=<a href='/topic/show?id=6e618332871' target=_blank style='color:#2F92EE;'>#胃肠道出血#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83328, encryptionId=6e618332871, topicName=胃肠道出血)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1b6a2500070, createdName=124987a0m66(暂无昵称), createdTime=Tue Jun 14 09:23:11 CST 2022, time=2022-06-14, status=1, ipAttribution=)]
    2022-06-14 124987a0m66(暂无昵称)

    #胃肠道出血#

    0

相关资讯

阿司匹林 + 替格瑞洛，适合中国人群的双抗治疗！

替格瑞洛联合阿司匹林治疗轻中度缺血性卒中或高危TIA患者，相较于单独使用阿司匹林，复发性卒中或死亡风险更低。

“神药”阿司匹林又添新功效，或将治疗胆道癌！

使用阿司匹林者的胆道癌特异性死亡风险降低45%。

JAMA：临床试验证实，阿司匹林可改善新冠重症患者生存率

近年来，阿司匹林被发现在多种疾病中有效，甚至对神经退行性疾病、心血管疾病、癌症等重大疾病也有着一定的预防和治疗效用。

Lancet：血管内卒中治疗期间阿司匹林、普通肝素的安全性和有效性研究 (MR CLEAN-MED)：症状性颅内出血风险增加，尚无证据表明有益功能结果！

研究者试图评估静脉注射阿司匹林、普通肝素在血管内治疗因前循环大血管闭塞导致的缺血性卒中的安全性和有效性。治疗期间围术期静脉注射阿司匹林和普通肝素均增加症状性颅内出血的风险，但无证据表明对功能结果有益。

JAMA：USPSTF不推荐≥60岁无心血管病老人使用阿司匹林！

新建议更新了2016年工作组关于使用阿司匹林预防心血管病和直肠癌的建议。

Eur Heart J：阿司匹林对糖尿病患者痴呆和认知功能的影响

阿司匹林对痴呆症的风险没有很大的比例效应。每日服用低剂量阿司匹林长达平均7.4年，对广义或狭义痴呆结局的风险均无统计学意义。

Baidu
map
Baidu
map
Baidu
map