雷贝拉唑联用黛力新治疗难治性胃食管反流病的临床观察-现代医学

雷贝拉唑联用黛力新治疗难治性胃食管反流病的临床观察

单位：解放军总医院第六医学中心消化内科, 北京 100048

分类号：R571.1

出版年·卷·期（页码）：2020·39·第三期（348-352）

摘要：

目的：通过观察氟哌噻吨美利曲辛（黛力新）对难治性胃食管反流病（GERD）的治疗作用，探讨精神状态对GERD致病的影响。方法：选取2015年1月至2017年10月在原海军总医院消化内科门诊和住院的112例难治性GERD患者，随机分为观察组（58例）和对照组（54例）。对照组给予雷贝拉唑规范治疗10 mg，每日2次，共12周；观察组给予雷贝拉唑相同剂量治疗8周后加用黛力新治疗4周，疗程均为12周。治疗前后进行焦虑自评量表（SAS）、抑郁自评量表（SDS）和胃食管反流病调查问卷（GERDQ）评分，以及24 h食管pH+阻抗检测。疗程结束后分析治疗效果。结果：两组治疗前后比较各量表积分差异均有统计学意义（P<0.05），而观察组治疗后各积分明显低于对照组（P<0.05）。两组治疗前后24 h食管pH+阻抗检测结果显示，观察组治疗后DeMeester积分、反流≥ 5 min的次数、最长反流时间以及反流次数均明显低于对照组；观察组治疗总有效率为89.7%，明显高于对照组的63.0%（P<0.05），其中观察组非糜烂性反流病组（NERD）治疗有效率高达94.9%。结论：改善患者精神状态能够提高GERD、尤其NERD的治疗效果，质子泵抑制剂联合精神调节药可作为治疗难治性GERD的经验用药。

Objective: To observe the treatment of rabeprazole combined with deanxit in refractory gastroesophageal reflux disease to explore the mental state in the role of improving the treatment of GERD.Methods: From January 2015 to October 2017 in Navy General Hospital, 112 outpatient and inpatient with refractory GERD were randomly divided into observation group (58 cases) and control group (54 cases). Patients in the control group were treated with single drug Rabeprazole for 8 weeks and patients in observation group were treated with Rabeprazole for 8 weeks combined with Deanxit for the later 4 weeks. SDS, SAS, GERDQ esophageal impedance and 24 h pH monitoring were detected before and after treatment, curative effect after treatment was analyzed.Results: SAS, SDS and GERDQ scores of patients in observation group were significantly lower than that of patients in the control group after therapy with a statistical difference (P<0.05). 24 h esophageal impedance and pH monitoring results showed that DeMeester score, reflux ≥ 5 min, the longest reflux time and reflux times of patients in the observation group were significantly lower than those of patients in the control group after therapy with a statistically significant difference (P<0.05). The total effective rate of the observation group 89.7% was significantly higher than that of the control group 63% (P<0.05), and the effective rate of observation group NERD was the highest in the four subgroups-94.9%.Conclusion: The improved mental state of GERD can increase the curative effect of GERD, especially for the NERD patients. Rabeprazole combined with Deanxit in the treatment of refractory GERD is very effective.

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