Evaluation Of Proton Pump Inhibitors In Preventing Stress Ulcer Bleeding After Partial Hepatectomy

PurposeAlthough the international guidelines recommend the use of a proton pump inhibitor(PPI)to prevent the occurrence of stress ulcer(SU),there is no clinical study that has proven that stress ulcer prevention(SUP)May improve prognosis.The use of proton pump inhibitors to prevent stress ulcer bleeding(SUB)during the perioperative period remains controversial.The purpose of this study was to observe the prophylactic effect of proton pump inhibitors on SUB after liver resection,and to determine whether PPI has an exact effect on the prevention of SUB.MethodsA total of 220 patients who were expected to undergo partial hepatectomy were randomly divided into a study group of 100 cases and a control group of 120 cases.The study group was routinely treated with liver protection,phlegm reduction,infection prevention,and conventional fluid replacement.The control group applied pantoprazole on the basis of conventional treatment.The incidence of stress ulcer bleeding in the two groups was observed.ResultsThere were no obvious black stool,vomiting,or hemorrhagic shock in the study group and the control group.There were 100 cases in the research group and 16 cases with positive stool occult blood test.The incidence of stress ulcer bleeding was 16%.There were 120 cases in the control group and 14 cases with positive stool occult blood test.The incidence of stress ulcer bleeding was 11.7%.There was no significant difference between the two groups(P > 0.05).The univariate analysis of the risk factors of stress ulcer bleeding after liver resection,mainly including the surgical method,operation time,intraoperative blood loss,preoperative liver cirrhosis,and whether hepatic hilar obstruction was performed during the operation.There was no statistical difference between the study group and the experimental group(P > 0.05).For comparison of proton pump inhibitor-related complications,17 cases(17.0%)of postoperative pneumonia occurred in the study group,and 35 cases(29.2%)of postoperative pneumonia occurred in the control group.The difference between the two groups was statistically significant(P <0.05).No other adverse reactions such as Clostridium difficile infection and renal insufficiency were seen in both groups.ConclusionThis study found that in patients undergoing partial liver resection,the perioperative application of proton pump inhibitors has no obvious clinical effect on the prevention of stress ulcer bleeding,but may increase the risk of pneumonia infection in patients after surgery.PPI is routinely applied to prevent stress ulcer bleeding after resection.Based on this study,a multi-center prospective clinical trial can be continued to further evaluate the efficacy of PPI in preventing SUB after liver resection and guide clinicians in rational drug use.