【作者】 柴小兵；

【导师】 秦云才；

【作者基本信息】 泰山医学院 ， 内科学， 2009， 硕士

【摘要】 目的分别使用奥美拉唑与雷尼替丁治疗老年人食管裂孔疝致反流性食管炎,并观察其疗效。方法选择2007年09月一2008年10月泰安市88医院消化科门诊及住院病人经内镜及X线检查,均证实有食管裂孔疝并反流性食管炎的80例患者,以随机数字表法将患者随机分为两组,治疗组40例,对照组40例。内镜检查80例,参照Savary-Miller的内镜食管分级,治疗组Ⅱ级15例,Ⅲ级7例,对照组Ⅱ级18例,Ⅲ级6例。X线检查,滑动型食管裂孔疝61例（占76.25%）,食管旁裂孔疝5例（6.25%）,混合型裂孔疝14例（17.5%）。治疗组口服奥美拉唑20mg,每日2次,餐前半小时服用;对照组口服雷尼替丁150mg,2次/天,两组疗程均为8周。隔8周复查内镜,每周记录病人症状。全部病例在入选时和治疗结束后均进行血、尿、粪,肝肾功能、血糖、血脂及心电图等常规指标的检测;参照反流性疾病问卷（refluxdiagnostic questionnaire,RDQ）,记录患者治疗前后烧心、反流、非心源性胸痛、反酸等症状的严重程度及发作频率积分,进行临床症状疗效评价;记录患者治疗前后胃镜检查结果,进行内镜下分级和积分评价,于停药16周后进行随访,观察其症状变化,评价复发情况。结果（1）参与者数量分析:采用电话联系等随访方法,80例患者全部进入结果分析。（2）两组患者一般资料差异性比较:两组患者之间的性别、年龄、病程、治疗前病情进行分析,结果两组患者无显著性差异,具有可比性（P>0.05）。（3）治疗前后胃镜下食管炎程度比较:治疗组和对照组有显著性差异（P<0.01）。（4）治疗前后胃镜下疗效比较:治疗组40例,治愈20例（50.00%）,有效12例（30.00%）,无效2例（5.00%）,总有效率为95.00%:对照组40例治愈14例（35.0%）,有效11例（27.5%）,无效9例（22.5%）,总有效率77.5%。治疗后两组患者胃镜下疗效比较,经X²检验,总有效率有差异（p<0.05）,治疗组总有效率明显高于对照组;痊愈率无差异（P>0.05）。（5）治疗后临床疗效比较:治疗组40例,临床治愈25例,显效11例,有效2例,无效2例,总有效率95.00%;对照组40例,临床治愈26例,显效10例,有效6例,无效8例,总有效率80.00%。经X2检验,两组治疗后总有效率比较,差异有显著性（P<0.05）。（6）两组复发情况比较:停药16周后治疗组随访35例,8例患者复发,复发率为22.86%;对照组随访30例患者,复发17例,复发率为56.67%。经X2检验,差异有非常显著性意义（P<0.01）。（7）安全性观测:两组患者均没有出现明显不良反应,患者能够耐受,两组患者均完成试验,没有病例因为严重不良反应而中断治疗。通过治疗前后血常规、尿常规、大便常规、肝肾功能、血糖、血脂及心电图检查,结果显示,各项检查均在正常范围,未发现有异常变化。结论H₂受体拮抗剂抑酸能力不足,奥美拉唑能抑制壁细胞中H⁺/K⁺-ATP酶阻断胃酸分泌的最终环节,且生物利用度随着重复给药而增加,这也决定了奥美拉唑强而持久的抑酸效果,使pH值提高接近中性,能够在短时间内消除胃酸对胃粘膜的侵蚀,并维持无酸状态,从而有利于炎症及溃疡的愈合。更多还原

【Abstract】 ObjectiveTo separate the use of Omeprazole and Ranitidine treatment of the elderly hiatal hernia reflux esophagitis, and to observe it’s effect.MethodsFrom September 2007 to October 2008, Gstroenterology dept of Taian city 88 hospital out-patient and 80 patients endoscopic and X-ray examination,who are proved to have hiatal hernia and reflux esophagitis. patients 80 to random number table will be randomly divided into two groups of patients, the treatment group 40 cases, 40 cases of the control group. 80 cases of endoscopy, in the light of the Savary-Miller grading esophageal endoscopy, the treatment group 15 cases of gradeⅡ,Ⅲgrade seven cases, the control group 18 cases of gradeⅡ,Ⅲgrade in 6 cases. X-ray examination, sliding hiatal hernia in 61 cases （accounting for 76.25%）, five cases of esophageal hiatal hernia side （6.25%）, mixed type hernia in 14 cases （17.5%）. Oral treatment group, omeprazole 20mg, daily 2 times, taking half an hour before dinner; control group oral ranitidine 150mg, 2 times / day, were treated for 8 weeks. Endoscopic review every eight weeks, patients recorded symptoms every week. All patients in the selected time and treatment were carried out after the end of the blood, urine, feces, liver and kidney function, blood glucose, blood lipids and ECG tests and other conventional indicators; the light reflux disease questionnaire （refluxdiagnostic questionnaire, RDQ）, recorded before and after treatment in patients with heartburn , reflux, non-cardiac chest pain, acid reflux symptoms and the severity of the attack frequency points for evaluation of clinical symptoms; recorded before and after treatment in patients with gastroscopy results of endoscopic evaluation of classification and points in drug after 16 weeks of follow-up to observe changes in their symptoms, recurrence of the situation of evaluation.Results（1）The number of participants in analysis: the use of telephone follow-up method, etc., 80 patients entered the final analysis.（2） The difference between the two groups of patients compared to general information: two groups of patients with gender, age, course of disease, an analysis of pre-treatment condition, results of comparable groups of patients （P>0.05）.（3） Before and after treatment the degree of endoscopic esophagitis compared: the treatment group and control group were significantly different （P<0.01）.（4） Before and after endoscopic treatment effects: treatment group 40 cases, 20 cases of cure （50.00%）, effective in 12 cases （30.00%）, 2 cases （5.00%）, total effective rate was 95.00 percent: the control group 40 cases of cure in 14 cases （35.0%）, effective 11 cases （27.5%）, nine cases of invalid （22.5%）, total effective rate of 77.5%. After treatment in patients with gastroscopy under the effect of the two groups compared by the X2 test, the difference between the total effective rate （p<0.05）, treatment group was significantly higher than the total effective rate; cure rate is no difference （P>0.05）.（5） Comparison of clinical efficacy after treatment: 40 cases of treatment group, 25 cases of clinically cured, 11 cases markedly effective in 2 cases, 2 cases ineffective, the total effective rate 95.00%; 40 cases of the control group, 26 cases of clinical cure, effective 10 cases, six cases of effective and ineffective in 8 cases, total effective rate of 80.00%. By the X² test, the two groups after treatment the total effective rate of comparison, the difference was significant （P<0.05）.（6） Relapse compared to the situation in the two groups: drug treatment group after 16 weeks of follow-up of 35 cases, eight cases of patients with recurrence, the recurrence rate was 22.86%; control group, 30 patients with follow-up, 17 cases of recurrence, the recurrence rate was 56.67%. By the X2 test, the difference was significant （P<0.01）.（7）The safety of observation: the two groups were not significant in patients with adverse reactions, patients are able to tolerate, two test cases were completed, no cases of serious adverse reactions due to the interruption of treatment. Through the blood before and after treatment, urine routine, stool routine, liver and kidney function, blood glucose, blood lipids and ECG results showed that, the examinations are normal, no abnormal changes were found.ConclusionH₂ receptor antagonists acid inhibitors inadequate capacity, omeprazole can inhibit the cell wall of the H⁺/K⁺-ATP-blocking the final link in gastric acid secretion, and bioavailability as the duplication of administration and increase, which also decided Omeprazole a strong and lasting effects of acid inhibitors, to improve the pH value of LES to neutral, in a short period of time on the Elimination of gastric acid erosion and to maintain the acid-free status, which is conducive to healing inflammation and ulcers.更多还原