發(fā)布時(shí)間：2018-11-08 20:29

【摘要】：目的： 觀察體表胃腸起搏聯(lián)合泮托拉唑治療輕中度胃食管反流病患者的臨床療效及其對(duì)胃腸激素的影響。 方法： 以符合納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的輕中度胃食管反流病患者63例隨機(jī)分成A、B兩組。A組31例予以泮托拉唑腸溶膠囊（40mg/Bid，2周）及多潘立酮片（10mg/Tid，2周）治療；B組32例患者予以泮托拉唑腸溶膠囊（40mg/Bid，2周）及體表胃腸起搏（30min/Bid，2周）治療。對(duì)所有患者治療前及治療2周后進(jìn)行癥狀積分、治療有效率、胃電圖、食管測(cè)壓、胃腸激素及不良反應(yīng)測(cè)定，對(duì)治療2周后癥狀完全緩解的患者進(jìn)行隨訪記錄原癥狀首次復(fù)發(fā)時(shí)間，利用SPSS計(jì)算機(jī)統(tǒng)計(jì)分析治療前后上述觀察指標(biāo)改變情況。 結(jié)果： 1．A、B兩組患者治療前癥狀積分無明顯差異（P＞0.05）；治療1周后B組有效率較A組高（P 0.05）；治療2周后2組患者有效率無明顯差異（P0.05）。 2．A、B兩組患者治療前LESP無明顯差異（P0.05），治療后兩組患者LESP均較治療前有升高（P 0.05），且B組較A組升高明顯（P 0.05）。 3．A、B兩組患者治療前胃電節(jié)律及餐后/餐前功率比均無明顯差異（P0.05），治療后B組患者較A組改善明顯（P 0.05）； 4．A、B兩組患者治療前胃動(dòng)素、胃泌素、膽囊收縮素均無明顯差異（P0.05），治療后B組患者較A組胃動(dòng)素及胃泌素含量均有升高（P 0.05），膽囊收縮素含量治療前、后無明顯差異（P0.05）。 5．在不良反應(yīng)方面，應(yīng)用體表胃腸起搏的B組患者中出現(xiàn)腹部皮膚局部灼傷1例（3.13%），排氣過多至不適者3例（9.38%）。服用多潘立酮的A組患者中出現(xiàn)腹瀉者2例（6.45%），排氣過多至不適者3例（9.68%）。 6．在首次復(fù)發(fā)時(shí)間方面，B組患者較A組患者明顯延長(zhǎng)（P 0.05）。 結(jié)論： 1．體表胃腸起搏聯(lián)合泮托拉唑治療方案能有效改善輕中度胃食管反流病患者的胃電節(jié)律、餐后/餐前功率比，增加食管下段括約肌壓力，并能提高血清胃動(dòng)素、胃泌素濃度，促進(jìn)胃動(dòng)力，減少反流的發(fā)生。 2．與多潘立酮聯(lián)合泮托拉唑治療方案相比，具有起效快，不良反應(yīng)小，，不易復(fù)發(fā)等特點(diǎn)，對(duì)輕中度胃食管反流病患者的治療有積極意義。
[Abstract]:Objective: to observe the clinical effect of superficial gastrointestinal pacing combined with pam Tora in the treatment of mild and moderate gastroesophageal reflux disease (GERD) and its effect on gastrointestinal hormones. Methods: Sixty-three patients with mild and moderate gastroesophageal reflux disease were randomly divided into two groups: group A (n = 31) received pam Tora enteric capsule (40 mg / Bidn 2 weeks) and domperidone tablet (10 mg / Tid). 2 weeks) treatment; In group B, 32 patients were treated with pamTora enteric capsule (40 mg / Bidn 2 weeks) and body surface gastrointestinal pacing (30 min / Bidder 2 weeks). Symptom score, effective rate, electrogastrogram, esophageal manometry, gastrointestinal hormones and adverse reactions were measured before and 2 weeks after treatment. After 2 weeks of treatment, the patients with complete remission of symptoms were followed up to record the first recurrence time of the original symptoms, and the changes of the above observed indexes were analyzed by SPSS computer statistical analysis before and after treatment. Results: 1. There was no significant difference in symptom score between two groups before treatment (P > 0.05), and the effective rate of group B was higher than that of group A one week after treatment (P 0.05). After 2 weeks of treatment, there was no significant difference in the effective rate between the two groups (P0.05). 2. There was no significant difference in LESP between group A and group B before treatment (P0.05). After treatment, the LESP of group B was higher than that of group A (P 0.05), and that of group B was significantly higher than that of group A. 3. There was no significant difference in gastric electric rhythm and postprandial / preprandial power ratio between group A and group B (P0.05), but there was significant improvement in group B compared with group A (P 0.05). 4. There was no significant difference in motilin, gastrin and cholecystokinin between two groups before treatment (P0.05). After treatment, the contents of motilin and gastrin in group B were higher than those in group A (P 0.05). There was no significant difference in cholecystokinin content before and after treatment (P0.05). 5. In group B, there were 1 case (3.13%) with abdominal skin burn and 3 cases (9.38%) with excessive exhaust and discomfort. In group A, diarrhea occurred in 2 cases (6.45%), and excessive exhaust in 3 cases (9.68%). 6. The time of first recurrence in group B was significantly longer than that in group A (P 0.05). Conclusion: 1. The combination of superficial gastrointestinal pacing and pam Tora therapy can effectively improve the gastric electric rhythm, postprandial / preprandial power ratio, increase the lower esophageal sphincter pressure and increase serum motilin in patients with mild and moderate gastroesophageal reflux disease. Gastrin concentration promotes gastric motility and reduces reflux. 2.Compared with the combination of domperidone and pam Tora, it has the characteristics of quick onset, less adverse reactions and less recurrence. It has positive significance for the treatment of patients with mild to moderate gastroesophageal reflux disease (GERD).
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R571

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