中文摘要：

目的系统评价不同给药方案质子泵抑制剂对内镜治疗成功止血的消化性溃疡出血患者疗效的影响。方法计算机检索Pub Med、Cochrane Library、Web of Science、EMbase、CNKI、VIP、万方数据库和万方医学网,对纳入的文献进行质量评价与数据提取后,采用Rev Man 5.2和Stata 12.0软件对数据进行合并分析。结果共纳入22篇文献,2 808例患者。Meta分析结果显示不同质子泵抑制剂给药方案对死亡率、再出血率、外科手术率和住院时间的影响总体上无显著差异。但按前72 h给药剂量行亚组分析时发现,剂量（≤120 mg）组的30 d内再出血发生风险高于高剂量组30 d内再出血发生风险（[RR（相对危险度,relative risk）=0.59,95%CI（0.37,0.94）,P=0.03]）,剂量（320 mg）组的72 h内再出血发生风险低于高剂量组（[RR=1.92,95%CI（1.02,3.62）,P=0.04]）。在需输血量上,剂量（320 mg）组和间歇给药方案低于高剂量持续给药组（[SMD（标准化均数差,standard mean difference）=0.33,95%CI（0.09,0.57）,P=0.008]、[SMD=0.11,95%CI（0.01,0.20）,P=0.03]）。结论对于内镜下成功止血的消化性溃疡出血患者,前72 h内间歇性、非高剂量质子泵抑制剂给药方案并不劣于指南推荐的连续高剂量质子泵抑制剂治疗方案。临床上建议结合患者的依从性和医疗成本,内镜治疗成功后可在前72 h内采用每日至少静脉给药两次、累积给予320 mg质子泵抑制剂的间歇性给药方案,如患者耐受经口给药,则相同剂量及频次经口给药的方案可能更为合理。

英文摘要：

Objective To evaluate the efficacy of different regimens of PPI of patients after successful endoscopic therapy with peptic bleeding ulcers. Methods Databases including Pub Med,The Cochrane Library,Web of Science,EMbase CNKI,VIP,Wanfang database and Wanfang medical network were searched. The data were extracted from the included literatures after the quality assessment and analyzed by Rev Man 5. 2 software and Stata 12. 0 software. Results A total of 22 articles involving 2 808 patients were included. The results of meta-analysis showed that no significant difference among the different regimens of PPI was observed regarding mortality,recurrent bleeding,requirement of surgery and length of hospital stay.But the subgroup analysis according to the first 72 hours showed that： recurrent bleeding risk within 30 d was higher in the patients of dose（ ≤120 mg）（ [RR = 0. 59,95% CI（ 0. 37,0. 94）,P = 0. 03]）,and lower in the patients of dose（ 320 mg）（ [RR = 1. 92,95% CI（ 1. 02,3. 62）,P = 0. 04 ]） compare to the high dose. The mean volume of blood transfused was significantly shortened in those using dose（ 320mg）,intermittent PPI therapy（ [SMD = 0. 33,95% CI（ 0. 09,0. 57）,P = 0. 008],[SMD = 0. 11,95% CI（ 0. 01,0. 20）,P =0. 03]）. Conclusions For the patients after successful endoscopic therapy with bleeding ulcers,intermittent,non-high dose PPI therapy demonstrate a similar effectiveness to the current guideline-recommended regimen of high dose and continuous PPI. Given the greater ease of use and lower cost,we would favor in the first72 h after successful endoscopic therapy,intravenous PPI given at least twice daily which total dose is320 mg,using oral PPI in patients able to tolerate oral medications as the same way after successful endoscopic therapy with bleeding ulcers.