针灸辅助质子泵抑制剂治疗难治性胃食管反流病63例临床观察

Clinical Observation on Acupuncture Assisting Proton Pump Inhibitor in the Treatment of 63 Cases of Refractory Gastroesophageal Reflux Disease

目的评价针灸对难治性胃食管反流病的辅助治疗作用。方法将148例难治性胃食管反流病患者随机分成治疗组和对照组各74例。治疗组给予针灸治疗,每次治疗30 min,每周3次,另外给予泮托拉唑肠溶胶囊每次40 mg,每日1次。对照组给予西医三联用药强化治疗。两组均连续治疗8周,随防期为12周。在治疗前、治疗后和随防期分别对两组患者进行反流性疾病问卷(RDQ)、胃食管反流病问卷(GERDQ)评分,于治疗前及随访期进行胃食管反流病相关生活质量量表(GERD-HRQL)评分,并对其中的反流性食管炎患者进行胃镜下炎症评分。治疗后判定临床疗效。结果治疗组63例、对照组60例完成了本试验。治疗组痊愈6例、显效19例、进步33例、无效5例,总有效率为92.06%;对照组分别为1例、7例、42例、10例及83.33%,治疗组临床疗效优于对照组(P<0.01)。治疗组的RDQ症状积分、频率积分、总积分及GERDQ评分在治疗后和随访期均较本组治疗前降低,并且治疗组较对照组降低更明显(P<0.05或P<0.01)。治疗组随访期GERD-HRQL评分低于对照组(P<0.05)。两组反流性食管炎患者胃镜下炎症评分较治疗前均明显降低(P<0.05),但两组治疗后比较差异无统计学意义(P>0.05)。结论针灸疗法辅助质子泵抑制剂治疗难治性胃食管反流病,可以明显改善患者的临床症状和生活质量,提高临床疗效。

Objective To evaluate the assisted therapeutic effect of acupuncture on refractory gastroesophageal reflux disease （RGERD）. Methods One hundred and forty-eight patients with RGERD were randomized into a treatment group （74 cases） and a control group （74 cases）. The treatment group was given acupuncture therapy, 30 min each time, 3 times every week. Besides, Pantoprazole enteric capsule was given, 40 mg each time, once every day. The control group was given three-drug-combination intensive treatment in Western medicine. Both groups were treated for 8 weeks. Follow-ups were made for 12 weeks. Reflux disease questionnaire （RDQ） and gastroesophageal reflux disease questionnaire （GERDQ） scores were used for evaluation in both groups before and after treatment, as well as in follow-up. Health Related Quality of Life Scale for Gastroesophageal Reflux Disease （GERD-HRQL） score was rated before treatment and in follow-up. Inflammation score under endoscopy was made on patients with reflux esophagitis. The clinical effect was evaluated after treatment. Results Sixty-three patients in the treatment group and 60 patients in the control group finished the trial. In the treatment group, there were 6 patients recovered, 19 markedly improved, 33 improved, and 5 invalid, with the total effective rate of 92. 06%. In the control group, there were one patient recovered, 7 markedly improved, 42 improved, and 10 invalid, with the total effective rate of 83. 33%. The total effective rate in treatment group was superior to that in the control group （P 〈 0. 01 ）. RDQ symptom score, frequency score, total score and GERDQ score in both groups decreased after treatment and in follow-up. The reduce in the treatment group was more significant than that in the control group （P 〈 0. 05 or P 〈 0. 01 ）. During the follow-up, GERD-HRQL score in the treatment group was lower than that in the control group （P 〈 0. 05 ）. Inflammation score under endoscopy of patients with reflux esophagitis in both groups decreased after treatment （ P 〈 0. 05 ）, but there was no significant difference in the scores between the two groups （ P 〉 0. 05 ）. Conclusion In treating RGERD, acupuncture therapy assisting proton pump inhibitor might relieve patients＇ clinical symptoms, improve quality of life, and enhance the clinical effect.