开结散痞汤联合西医治疗胃食管反流病的临床疗效及对患者胃肠激素、食管酸暴露的影响

Clinical effect of Kaijie Sanpi decoction combined with western medicine on gastroesophageal reflux disease and its influence on gastrointestinal hormone and esophageal acid exposure

目的观察开结散痞汤联合西医治疗胃食管反流病的临床疗效及对患者胃肠激素、食管酸暴露的影响。方法将156例胃食管反流病患者按照随机数字表法分为2组。对照组78例予奥美拉唑、西沙必利治疗;观察组78例在对照组治疗基础上加用开结散痞汤治疗。2组均治疗28d后统计临床疗效,并观察2组治疗前后血清胃肠激素[胃泌素(GAS)、胃动素(MTL)、P物质(SP)和血管活性肠肽(VIP)]情况,并采用24h双通道阻抗/pH反流监测系统获取食管酸暴露的观察指标,观察不良反应发生情况。结果观察组总有效率96.15%,对照组总有效率74.36%,观察组疗效优于对照组(P<0.05)。治疗后观察组GAS、MTL及SP水平均较本组治疗前升高(P<0.05),VIP水平较本组治疗前降低(P<0.05),且观察组GAS、MTL及SP水平高于对照组(P<0.05),VIP水平低于对照组(P<0.05)。治疗后观察组酸暴露频率、持续5min以上的反流次数均较本组治疗前减少(P<0.05),pH<4的反流时间百分比、DeMeester评分均较本组治疗前降低(P<0.05),最长反流时间较本组治疗前缩短(P<0.05),且与对照组治疗后比较差异均有统计学意义(P<0.05)。对照组治疗前后胃肠激素水平及食管酸暴露的观察指标比较差异均无统计学意义(P>0.05)。观察组不良反应发生率低于对照组(P<0.05)。结论开结散痞汤联合西医治疗能有效控制胃食管反流病的临床症状,调节胃肠激素,减轻食管酸暴露,安全性较好。

Objective To observe the clinical efficacy of Kaijie Sanpi decoction combined with western medicine on gastroesophageal reflux disease and its influence on gastrointestinal hormone and esophageal acid exposure. Methods 156 patients with gastroesophageal reflux disease were divided into two groups according to random number table method. 78 cases in control group were treated by omeprazole and cisapride. 78 cases in observation group were treated by Kaijie Sanpi decoction on the basis of the control group. After 28 days of treatment, the clinical efficacy of the two groups was evaluated. The levels of serum gastrointestinal hormones [gastrin(GAS), motilin (MTL), substance P(SP) and vasoactive intestinal peptide (VIP)]were observed before and after treatment in the two groups. The 24-hour dual-channel impedance/pH reflux monitoring system was used to obtain the indicators of esophageal acid exposure and observe the occurrence of adverse reactions. Results The total effective rate was 96.15% in observation group and 74.36% in control group. The clinical curative effect of the observation group was better than that of the control group ( P <0.05). After treatment, the levels of GAS, MTL and SP in the observation group were higher than those before treatment ( P <0.05), and the level of VIP was lower than that before treatment ( P <0.05), and the levels of GAS, MTL and SP in the observation group were higher than those in the control group ( P <0.05), and the level of VIP was lower than that in the control group ( P <0.05). After treatment, the acid exposure frequency and reflux times lasting for more than 5 minutes in the observation group were all lower than those before treatment ( P <0.05), the percentage of reflux time and DeMeester score of pH < 4 were lower than those before treatment ( P <0.05), and the longest reflux time was shorter than that before treatment ( P <0.05), and there were significant differences between the two groups after treatment ( P <0.05). There was no significant difference in gastrointestinal hormone level and esophageal acid exposure before and after treatment in the control group ( P >0.05). The incidence of adverse reactions in the observation group was lower than that in the control group ( P <0.05). Conclusion Kaijie Sanpi decoction combined with western medicine can effectively control the clinical symptoms of gastroesophageal reflux disease, regulate gastrointestinal hormones, reduce the exposure of esophageal acid, and have better safety.