胃食管反流性疾病不同疗法的总体评价(附112例临床分析)

Evaluation of different therapy on gastroesophageal reflux disease

目的 了解胃食管反流性疾病对患者生活质量的影响,评价两种“三联疗法”对胃食管反流性疾病的疗效及生活质量,经济投入的影响。方法 通过丽水市6所市、县级人民医院收集同期经胃镜确诊的反流性食管病例,采用问卷调查方式,了解受试者的一般情况,胃食管反流症状和疾病前后生活质量,经济投入改变情况,分别给予质子泵抑制剂+促动力剂+黏膜保护剂(方案甲),及H_2受体阻滞剂+促动力剂+黏膜保护剂(方案乙)8周治疗。记录治疗后患者生活质量(QOL)表和经济投入量表。探讨两种“三联疗法”的疗效,生活质量改变情况和经济投入关系。结果①共收集112例GERD病例,男女比24:1,平均年龄47.9+13.8岁,两组患者的临床资料具有可比性(P>0.05);②甲方案总有效率92.98%,乙方案总有效率80％。甲方案疗效优于乙方案。③GERD严重影响QOL,优质QOL由发病前63.7％降至13.7％,甲方案治疗后可恢复优质QOL至84％,乙方案为63％。两种方案经济投入无显著差异(P=0.085)。④疗效和生活质量改善有显著相关性。结论“三联疗法”治疗胃食管反流性疾病疗效高,并可显著改善患者的生活质量。以兰索拉唑促动力剂+黏膜保护剂三联组更为明显。此三联疗法是经济、高效和有效提高生活质量的疗法,值得推广。

Objective To understand the influence of gastroesophageal reflux disease (GERP) on quality of living (QOL),and evaluate therapeutic effect as well as influence on QOL and cost of two kinds of triple therapy. Methods The patients with GERP from six municipal hospitals of Lishui which have been diagnosed by gastroscope were studied. General condition, symptom, QOL before and after treat and cost in the dlisease were acquired by questionaire. The patients were given PPI combined with motive drug and mucosa-protected drug (scheme A) and H2RAs combined with motive drug and mucosa-protected drug ( scheme B) for 8 weeks respectively. The table of QOL and cost were recorded. The relationship between therapeutic effects, the changes of QOL and the cost were studied. Results (1)112 cases of patients with GERD were collected, the ratio of male to female was 2.4 to 1 , average ages were 47 .9±13.8, the clinical references of two groups were comparable ( P > 0 .05) . (2) The total efficacy of scheme A and B was 92 .98 % and 80 % respectively, and A was superior lo B.(3)QOL were influened seriously by GERD, the QOL of high quality decreased from 63.7% to 13.7% in patients with GERD, and that could be restored to 84 % and 63 % through scheme A and B respectively . There were no significant difference in cost between the two schemes.(4)There were significant correlation between therapeutic effects and improvement of QOL. Conclusions The effect of triple therapy to GERD is obvious, and can improve the QOL significantly.The effects of Lansoprazole combined with motive drug and mucosa-protected drug are more significant. This therapy is economical, high efficient and can improve QOL effectively, so it deserves to be spreaded.