抗胃食管反流治疗对老年人不明原因慢性咳嗽的疗效观察

Effct of anti-gastroesophageal reflux treatment for chronic cough in the elderly without definite cause

目的观察抑酸抗反流治疗对老年人原因不明咳嗽的疗效和治疗有效病人中胃食管反流病(GERD)的发病情况。方法40名已经用过1周以上抗菌素治疗无效,不服用ACEI的老年慢性咳嗽病人,被随机分为2组。A组给予雷贝拉唑10mg qd,莫沙比利5mg tid2周,B组第1周投药同A组,第2周加给拜复乐0.4qd。第1周和第2周末统计疗效。随访治疗有效和显著有效的16例病人,慢性咳嗽复发时作质子泵抑制试验,诊断GERD病例。结果第1周A、B两组平均有效率为27.5%,其中显著有效率17.5%,评分1.11±0.56;第2周A组有效率为35.0%,其中显著有效率为20.0%,评分为1.26±0.44;B组有效率为45.0%,显著有效率为25.0%,评分1.53±0.51。B组2周末评分与1周末相比有统计学意义(P<0.05)。质子泵抑制试验表明,治疗有效或显著有效的病人中81%试验阳性。结论老年人不明原因慢性咳嗽用抑酸抗反流治疗2周后有效率为35%,质子泵实验表明这些老人基本都是GERD病人,这些老年人的咳嗽是GERD的食管外症状。加用抗菌素疗效更佳,提示老年人不明原因咳嗽是多种原因引起的。

Objective To observe the effect of anti-acid plus anti-reflux treatment in elderly chronic cough patients without definite cause and GERD prevalence in the patients who showed effective. Methods 40 elderly chronic cough patients, who had taken antibiotics for more than 1 week and did not take ACEI, were divided into 2 groups randomly. Patients in A group were given rabeprazole 10 mg qd, mosapride 5 mg tid for 2 weeks, patients in B group wen given the same medicines as group A in first week and avelox 0.4 g qd was added in the second week. Effect was analyzed in the end of first and second week. Results Average effective ratio of A and B group was 27.5%, and obvious effective ratio was 17.5%, curing point 1.11 ± 0.56 in the end of first week; whereas effective ratio of A group was 35.0%, ohvious effective ratio was 20.0%, and curihg point 1.26 ± 0.44, effective ratio of B group was 45.0%, obvious effective ratio was 25.0%, curing point 1.53 ± 0.51 in the end of second week. Significant difference was existent between curing point of B group in the end of second week with the point in the end of first week. Proton pump inhibit test showed that positive ratio was 81% in the patients who showed effective after treatment. Conclusions After anti-acid plus anti-reflux treatment for 2 weeks, effective ratio was 35% in elderly chronic cough patients without definite cause, proton pump test showed that most of these patients were ill with GERD, their cough was the extra-esophagus symptom of GERD. The effect was more ohvious when antibiotics were added. It indicated that multiple causes induced chronic cough of elderly patients without definite cause.