【摘要】：目的： 比較三聯(lián)聯(lián)合益生菌與三聯(lián)療法在根除幽門螺桿菌、改善消化道癥狀、藥物副作用發(fā)生率及成本-效果分析方面的差異，為臨床提供一個(gè)幽門螺桿菌根除率高、不良反應(yīng)少及成本較低的治療方案.。 方法： 選取來延安大學(xué)附屬醫(yī)院消化內(nèi)科的門診就診有胃腸道癥狀（反酸、燒心、口苦、早飽、噯氣、上腹痛、腹脹、惡心、嘔吐等）的患者，，經(jīng)胃鏡檢查確診為十二指腸球部潰瘍活動(dòng)期，且14C尿素呼氣試驗(yàn)檢查陽(yáng)性的患者90例，年齡18歲以上者，隨機(jī)分為治療組（益生菌與三聯(lián)：雙岐四聯(lián)活菌片1g＋阿莫西林克拉維酸鉀分散片0.45g＋克拉霉素分散片0.25mg＋奧美拉唑腸溶膠囊20mg bid）、對(duì)照組（三聯(lián)：阿莫西林克拉維酸鉀分散片0.45g＋克拉霉素分散片0.25mg＋奧美拉唑腸溶膠囊20mg bid），兩組療程均為14天，根除Hp治療2周結(jié)束后繼續(xù)服用奧美拉唑腸溶膠囊20mg bid6周，雙岐四聯(lián)活菌片不與抗菌藥同時(shí)服用，在服用抗生素2小時(shí)后再服用雙岐四聯(lián)活菌片，于門診向患者說明服藥劑量及次數(shù)，治療期間告知按時(shí)服藥，并電話隨訪病人的胃腸道癥狀改善情況及是否出現(xiàn)藥物副作用，療程結(jié)束后2周復(fù)查14C尿素呼氣試驗(yàn)來判斷Hp根除情況。 結(jié)果： 治療過程中有4例患者失訪，3例拒絕隨訪，1留的手機(jī)號(hào)碼未打通，治療組的Hp根除率意向性分析（ITT）與符合方案分析（PP）分別是86.67%、90.69%，而對(duì)照組的Hp根除率意向性分析（ITT）與符合方案分析（PP）分別是82.23%、86.04%。治療組Hp根除率高于對(duì)照組，但無統(tǒng)計(jì)學(xué)意義，治療組和對(duì)照組的藥物副作用發(fā)生率分別為4.65%、20.93%，經(jīng)過檢驗(yàn)有統(tǒng)計(jì)學(xué)意義。治療組和對(duì)照組根除Hp的成本分別為398.9元、302.3元，治療組的成本比對(duì)照組低96.6元。 結(jié)論： 1．三聯(lián)聯(lián)合益生菌與三聯(lián)治療Hp陽(yáng)性的十二指腸潰瘍相比，其藥物副作用發(fā)生率低，提高了治療的耐受性。 2.三聯(lián)聯(lián)合益生菌與三聯(lián)都有可以接受的Hp根除率，且可以明顯改善患者的胃腸道癥狀。 3.三聯(lián)聯(lián)合益生菌與三聯(lián)在根除H.pylori感染上療效、臨床癥狀緩解及潰瘍愈合情況相似。 4．三聯(lián)聯(lián)合益生菌依從性好，且成本無明顯差別,效價(jià)比高，可考慮作為根除Hp的一種方案，為臨床推廣。
[Abstract]:Objective: to compare the differences between triple probiotics and triple therapy in eradication of Helicobacter pylori, improvement of gastrointestinal symptoms, incidence of side effects and cost-effect analysis. To provide a clinical high eradication rate of Helicobacter pylori, less adverse reactions and low cost of treatment. Methods: patients with gastrointestinal symptoms (acid reflux, heartburn, bitter mouth, early satiety, belching, upper abdominal pain, abdominal distension, nausea, vomiting, etc.) were selected. 90 patients with active duodenal ulcer diagnosed by gastroscopy and positive by 14C urea breath test were over 18 years old. They were randomly divided into treatment group (probiotics and triplet: bifidobacterium tablet 1g + amoxicillin clavulanate potassium dispersible tablet 0.45g + clarithromycin dispersible tablet 0.25mg + omeprazole enteric-coated capsule 20mg bid), control group) (triplex: amoxicillin carat) The course of treatment of 0.45g + clarithromycin dispersible tablets 0.25mg + omeprazole enteric-coated capsule 20mg bid), was 14 days. Omeprazole enteric-coated capsule 20mg bid6 was continued at the end of 2 weeks after eradication of Hp treatment. Bifidobacterium tetracycline tablets were not taken at the same time as antimicrobial agents, and then bifidobacterium tablets were taken 2 hours after taking antibiotics. To explain the dosage and times of medication to the patients in the outpatient clinic, to inform them of taking the medicine on time during the treatment period, and to follow up by telephone the improvement of gastrointestinal symptoms and the occurrence of side effects of the drugs. The 14 C urea breath test was performed 2 weeks after treatment to determine the eradication of Hp. Results: during the course of treatment, 4 patients lost a visit, 3 refused to follow up, and 1 cell phone number was not answered. Intentionality analysis of Hp eradication rate in treatment group (ITT) and coincidence analysis (PP) were 86.6767 and 90.69, respectively, while (ITT) in Hp eradication rate in control group and (PP) in conformance analysis were 82.230.04 and 86.04respectively. The eradication rate of Hp in the treatment group was higher than that in the control group, but there was no statistical significance. The side effects of the treatment group and the control group were 4.65 and 20.93, respectively. The cost of eradicating Hp in the treatment group and the control group was 398.9 yuan and 302.3 yuan respectively. The cost of the treatment group was 96.6 yuan lower than that of the control group. Conclusion: 1. The combination of probiotics and probiotics in the treatment of Hp positive duodenal ulcer, the incidence of drug side effects is lower, improved the tolerance of treatment. 2. The combination of probiotics and probiotics has an acceptable Hp eradication rate, and can significantly improve gastrointestinal symptoms in patients with 3. 3%. The efficacy of triple probiotics and triple probiotics in the eradication of H.pylori infection, clinical symptom relief and ulcer healing are similar. 4. The compliance of triple probiotics is good, and there is no significant difference in cost, and the titer ratio is high. It can be considered as a scheme to eradicate Hp for clinical promotion.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R573.1

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