非類固醇類消炎藥相關之消化道潰瘍

Non-Steroidal Anti-Inflammatory Drugs-Related Peptic Ulcer

章振旺(Chen-Wang Chang) ； 張文熊(Wen-Hsiung Chang) ； 林錫泉(Shee-Chan Lin) ； 王鴻源(Horng-Yuan Wang) ； 朱正心(Cheng-Hsin Chu) ； 王蒼恩(Tsang-En Wang) ； 林宜宗(I-Tsung Lin) ； 施壽全(Shou-Chuan Shih)

《內科學誌》 20卷3期 (2009/06) Pp. 203-208

https://doi.org/10.6314/JIMT.2009.20(3).02

摘要

在台灣約有25.6%的門診病患會使用除了aspirin外的其他非類固醇類消炎藥(non-steroidal anti-inflammatory drugs, NSAIDs)；使用NSAIDs藥物有20%的病患會有消化道潰瘍的產生，其中1-4%會因消化道潰瘍而產生其他併發症，如出血或胃穿孔；隨著藥物的進步，消化道潰瘍病患逐年下降，但其中因NSAIDs引起之潰瘍之比率卻是逐年增加，而且死亡率高；現階段有很多藥物可用於治療或預防NSAIDs引起之消化道潰瘍，在治療方面，H2接受器拮抗劑(histamine H2-receptor antagonists, H2RA)、質子幫浦抑制劑(proton pump inhibitors, PPI)或其它黏膜保護劑都有一定的效果；在預防方面，對於無風險的病患建議使用低風險之NSAIDs，並盡可能使用較低劑量，對於有風險的病患，可依風險高低，適時改用選擇性COX-2抑制劑以減少對腸胃道的傷害，或在使用NSAIDs時合併H2接受器拮抗劑或質子幫浦抑制劑…等，也可減少部分NSAIDs引起之潰瘍。所以當病患可能發生潰瘍時，停用NSAIDs改使用替代藥物或適時合併使用抗潰瘍藥物有助於潰瘍之預防及治療。

關鍵字

非類固醇類消炎藥 ； 消化道潰瘍

並列摘要

Except of aspirin, non-steroidal anti-inflammatory drugs (NSAIDs) were prescribed in 25.6% patientsin outpatient services in Taiwan. Peptic ulcer disease was found in 20% patients during taking NSAIDs, and1-4% patients suffered from other complications, such as bleeding or perforation. Incidence of peptic ulcers decreased now but an increasing proportion is related to NSAID and the mortality is high. There are several drugs prescribing for treatment or prevention of NSAIDs-related ulcer. Selective COX-2 inhibitors, histamine H2-receptor antagonists and proton pump inhibitors are prescribed for treatment of NSAIDs-related ulcer. In addition, prevention of NSAIDs-related ulcer must be in accordance with risk. Least ulcerogenic NSAIDs are prescribed for the patient without risk. In patient with risks, NSAIDs may be shifted to selective COX-2 inhibitors or combined with H2-receptor antagonists or proton pump inhibitors according to the risks.

並列關鍵字

NSAIDs ； Peptic Ulcer