Author: Rui Min, Huangshan People's Hospital
Ms. Lin, 72 years old this year, felt epigastric pain at more than 6 o'clock one morning, continued to aggravate, the family quickly sent Ms. Lin to the local county hospital, there was no obvious improvement after symptomatic treatment, immediately transferred to a tertiary hospital, with duodenal ulcer, acute diffuse peritonitis admitted to the hospital, emergency laparotomy surgery, intraoperative antrusion can see a diameter of about 1.5cm perforation, intestinal space to see a large amount of pus and food residue. After completing the perforation and repair of duodenal ulcer, he was transferred to the Intensive Care Department for observation.
<h1 class="pgc-h-arrow-right" data-track="41" > Ms. Lin has no history of gastric ulcers before, why is there a gastric perforation? </h1>
After Ms. Lin gradually recovered, on the basis of a detailed understanding of the patient's recent life history, basic disease history, and medication history, the real culprit that led to gastric perforation gradually surfaced, and it turned out to be diclofenac sodium.
Ms. Lin has been living in rural areas for a long time, and was hospitalized for gout attacks 5 years ago, and was diagnosed with gout, hyperuricemia, hypertension, and old cerebral infarction. After returning home, did not adhere to regular drug treatment, did not follow up, self-purchased diclofenac sodium oral control when gout attack, analgesic effect is better, 5 years of home often prepared the drug, take irregular, depending on the analgesic effect plus or minus the dose or frequency of administration. Ms. Lin recalled that in the past two years, she often felt stomach discomfort, and indeed it was more obvious after taking diclofenac sodium.
<h1 class="pgc-h-arrow-right" data-track="7" > diclofenac sodium</h1>
It is a nonsteroidal anti-inflammatory analgesic drug derived from phenylacetic acid, and its mechanism of action is to inhibit cyclooxygenase activity, thereby blocking the conversion of arachidonic acid to prostaglandins. At the same time, it can also promote the binding of arachidonic acid and triglycerides, reduce the concentration of free arachidonic acid in cells, and indirectly inhibit the synthesis of leukotriene. Thus producing analgesic, anti-inflammatory, antipyretic effect.
<h1 class="pgc-h-arrow-right" data-track="40" > adverse reactions</h1>
■ Gastrointestinal reactions: about 10% of people taking drugs, mainly stomach discomfort, burning sensation, acid return, sodium, nausea, etc., gastrointestinal damage is the most common adverse reactions of such drugs. Including gastritis, esophagitis, gastric and duodenal ulcers, severe gastrointestinal bleeding, perforation and obstruction.
■ Nervous system manifestations include headache, dizziness, drowsiness, excitement, etc.;
■ Cause edema, oliguria, electrolyte disorders and other adverse reactions, mild can disappear after discontinuation of the drug and corresponding treatment;
■ Other rare ones have transient elevation of serum aminotransferases, and in rare cases jaundice, rash, arrhythmia, granulocytopenia, thrombocytopenia, etc. appear. It can be restored after discontinuation.
<h1 class="pgc-h-arrow-right" data-track="42" >not use caution</h1>
Diclofenac sodium can penetrate through the gastric mucosa epithelial lipoprotein membrane layer, destroying the protective effect of the lipoprotein membrane, so that the gastric acid can be reversibly diffused into the tissue damage cells, causing capillaries to break and bleed, long-term repeated damage, resulting in gastric mucosa ulcer erosion, and even perforation, resulting in serious consequences.
Nonsteroidal anti-inflammatory drugs including diclofenac sodium are commonly used clinical antipyretic analgesics, such as ibuprofen, acetaminophen, aspirin, etc., which are very familiar to most people, short-term use is very safe, but because of many diseases such as patients involving moderate to severe chronic pain (osteoarthritis, acute onset of gout, cancer pain), patients may be long-term or repeated medication because of the need for treatment, if this is the case, patients must not be paralyzed, It is important to understand the risk that long-term administration of this class of drugs may lead to damage to the digestive tract.
<h1 class="pgc-h-arrow-right" data-track="43" > pharmacist reminder</h1>
Age >65 years, with helicobacter gastrointestinal pylori infection (more than 50% of the incidence in Chinese population, that is, 1 infection in every 2 people), a previous history of ulcer disease, a combination of various underlying diseases (e.g., cardiovascular disease, diabetes), and more daily medication. If you meet these conditions, you have to be careful when taking these drugs.
Of course, there are high risk factors that are not absolutely unusable, and you need to do the following:
Determine if you are infected with Helicobacter pylori gastric infection, and if so, please standardize treatment to do so that it must be removed.
You can choose to upgrade drugs in this class of drugs with relatively small side effects, such as selective cyclooxygenase (COX-2) inhibitor celecoxib, etc., of course, if you take it for a long time, you should still be careful of the same risks.
If you must take this class of drugs for a long time for various reasons and accompanied by a variety of high risk factors, be sure to regularly assess the risk of bleeding with the help of a doctor, even if you do not feel the discomfort of the stomach, such as the decline of hemoglobin, fecal occult blood may mean that there may be early gastrointestinal mucosal lesions, at this time the need for omeprazole, ranitidine and other drugs that inhibit gastric acid to prevent or repair the gastric mucosa.
During the medication period, avoid tobacco and alcohol stimulation, regular work and rest, choose the right medicine and use the right medicine, you say?
Review expert: Huangshan People's Hospital Deputy Director Pharmacist Zhu Zhonghua
The above is the original work of the volunteers of the "Drug Safety Cooperation Alliance", if you reprint, please indicate the author and source!
【Medicine Shield Public Welfare】PSM Pharmaceutical Shield Public Welfare (public number: PSMChina), a public welfare organization jointly initiated and established by the China Over-the-Counter Drug Association, the Chinese Pharmaceutical Association, etc., gathers resources, gathers strength, and promotes the safety of public medication.