老年人胃食管反流病及其治疗

Nocturnal acid breakthrough in elderly patients with gastroesophageal reflux disease and its management

目的 了解老年胃食管反流病（GERD）患者夜间酸突破现象（NAB）及制定治疗方案。方法 胃镜确诊GERD患者32例，随机分为4组（分别为A、B、C、D组），每组8例。A组：奥美拉唑（商品名洛赛克）20mg，每日1次口服（晨6时），B组：奥美拉唑20mg，每日2次口服（晨6时及临睡前服），C组：奥美拉唑40mg，每日2次口服（晨6时及临睡前服），D组：奥美拉唑20mg，每日1次口服（晨6时），同时临睡前加服雷尼替丁150mg。所有患者于用药治疗第5天连续24h监测胃内pH值。结果 NAB发生情况：A组5例，较B组1例、C组0例和D组2例明显增多（P〈0．05）。结论 老年GERD患者的NAB发生与奥美拉唑的用药剂量、用药方法有明显关系，在使用奥美拉唑基础上夜间睡前服用小剂量H2受体拮抗剂（不能长期用）能明显减少NAB的发生。

Objective To investigate the management of nocturnal acid breakthrough （NAB） in elderly patients with gastroesophageal reflux disease（GERD）. Methods Thirty two elderly patients with GERD confirmed by gastroscopy were randomly divided into four groups, eight patients in each group. Patients were treated by the following strategies [or 5 days： group A （omeprazole 20 mg per day orally in the morning）, group B （omeprazole 20 mg twice a day orally in the morning and at bed time）, group C （omeprazole 40 mg twice a day orally in the morning and at bed time）, group D （omeprazole 20 mg per day orally in the morning plus ranitidine 150 mg at bed time）. Intragastric pH over 24 hours was recorded at the morning of the fifth day for each patient. Results In comparison with that in group A, intragastric pH was higher in the other 3 groups. The incidence of NAB in group A （5/8） was significantly higher than that in the other 3 groups （P〈0. 05）. Conclusions The prevalence of NAB is closely related to the dosage and approach to the administration of omeprazole. The regimen of both ranitidine and omeprazole can decrease the prevalence of NAB in the elderly.