雷贝拉唑联合莫沙必利对老年人难治性胃食管反流病的疗效

目的探讨雷贝拉唑联合莫沙必利治疗难治性胃食管反流病（GERD）的作用。方法采用随机对照的方法，将32例老年难治性GERD患者分为雷贝拉唑组＋莫沙必利（LM）组和莫沙必利组（M）组。LM给予雷贝拉唑（波利特，卫材）10mg口服，2次，d和莫沙必利（新络纳片，康宏）5mg口服，3次，d；M组给予莫沙必利（新络纳片，康宏）5mg，口服，3次，d，两组疗程均为14d。实验前后均行阻抗一pH监测了解反流物性质和反流次数。结果经治疗后，LM组总有效率高于M组（62．5％vs25．O％，P=O．033），2组患者总反流次数均减少（P〈O．001）。LM组弱酸反流与治疗前比较减少，差异有高度统计学意义（P〈0．001），非酸反流的次数减少（P=0．002）；M组患者的弱酸反流和非酸反流次数经治疗后减少，差异有高度统计学意义（P〈0．001），但是酸反流的次数却增多，差异同样有高度统计学意义（P〈0．001）。LM组和M组患者的液体反流、液气混合反流的次数与治疗前比较减少（P=0．016，P=0．002；P=0．045，P=0．001），气体反流减少（P〈0．001）。结论联合应用雷贝拉唑和莫沙必利能改善难治性GERD患者的症状，效果优于单用莫沙必利。反流总次数和气体反流次数的减少可能在难治性GERD患者的症状改善中起一定的作用。

Effect of rabeprazole and mosapride on the treatment of refractory gastroesophageal reflux disease in elderly patients

Objective To investigate the therapeutic effect of rabeprazole and mosapride on the treatment of refractory gastroesophageal reflux disease （GERD）. Methods A total of 32 elderly refractory GERD patients were divided into LM group and M group. Patients in LM group were given rabeprazole 10mg two times daily and mosapride 5mg three times daily for 14 days, while patients in M group were given mosapride 5mg three times daily for 14 days. Impedance-pH moni- toring experiments were performed before and after the treatment to understand the nature and times of the reflux. Results The total effective rate of LM group was 62.5 %, which was significantly higher than that of M group （25.0 %）. The total reflux times was very significantly reduced after treatment in both LM group and M group （P〈0.001）. Weak acid and non-acid reflux of LM group was both very significantly reduced （P〈0.001 and P=0.0002） after treatment. Weak acid reflux and non-acid reflux of M group were very significantly reduced （P〈0.001） after treatment, while the acid reflux times was very significantly increased （P〈0.001）. The numbers of liquid and liquid-gas reflux were significantly reduced （P=0.016, P=0.002; P=0.045, P=0.001） and that of gas reflux was very significantly reduced （P〈 0.001）. Conclusions Rabeprazole and mosapride are effective in the treatment of refractory gastroesophageal reflux disease, and has better effect than single mosapride used. Reduced total number of reflux and the number of gas reflux may play a role in improving symptoms of refractory GERD patients.