莫沙必利联合聚乙二醇4000治疗慢性功能性便秘疗效观察

目的:观察莫沙必利联合聚乙二醇4000散剂治疗慢性功能性便秘的疗效.方法:117例经确诊的慢性功能性便秘患者随机分为3组,治疗组(A组)52例,给予口服莫沙必利5 ms/次,3次/天,聚乙二醇4000散剂10g/次,2次/天;对照组又分为B组和C组,B组34例,口服莫沙必利5 mg/次,3次,天,C组31例,口服聚乙二醇4000散剂10g/次,20/天,疗程均为15天.治疗后观察患者大便次数、大便形状及大便困难等症状缓解情况.结果:治疗15天后,3组总有效率分别为94.2%,58.8%,74.2%,治疗组与对照组相比较差异有显著性(P＜0.01).结论:莫沙必利联合聚乙二醇4000散剂治疗慢性功能性便秘疗效满意,不良反应少,是目前治疗功能性便秘的可行方案.     

小麦纤维素对比乳果糖在儿童功能性便秘中的临床应用

目的 探讨小麦纤维素对比乳果糖在儿童功能性便秘中的近期临床治疗价值和停药后的复发情况.方法 对2012年1月至2013年12月在我院门诊就诊的135例功能性便秘患儿,根据家属意愿选择分为纤维素组45例、乳果糖组48例和对照组42例,纤维素组口服小麦纤维素加思连康,乳果糖组口服乳果糖加思连康,对照组口服思连康,观察用药2周的临床效果和停药2周后的复发情况.结果 纤维素组有效42例,复发9例;乳果糖组有效30例,复发22例;对照组有效9例,复发6例,经统计学检验,三组之间治疗效果差异有统计学意义（P＜0.05）,纤维素组效果优于乳果糖组和对照组,乳果糖组优于对照组.复发情况比较,纤维素组低于乳果糖组和对照组（P＜0.05）,乳果糖组和对照组比较差异无统计学意义（P＞0.05）.结论 小麦纤维素对比乳果糖治疗儿童功能性便秘近期效果显著,停药后复发少,值得临床应用.     

乳果糖联用莫沙比利治疗帕金森症便秘临床疗效观察

目的：观察比较莫沙比利联合乳果糖口服溶液治疗帕金森症便秘疗效及安全性。方法将64例患者按随机、双盲法分为治疗组和对照组各32例,对照组用乳果糖口服溶液15 ml／次,晨起1次口服,疗程2周。治疗组用乳果糖口服溶液15ml／次,晨起1次口服;同时口服莫沙比利5mg,3次／次,疗程2周。2周后观察患者治疗情况和药物不良反应。结果治疗组总有效率为81．3％明显高于对照组的56．3％,2组比较差异有统计学意义（ P＜0．05）。结论乳果糖口服溶液联合莫沙比利治疗帕金森患者便秘比单独使用乳果糖口服溶液疗效更确切。     

莫沙比利联合乳果糖治疗功能性便秘疗效观察

目的评价莫沙比利联合乳果糖治疗功能性便秘的临床疗效。方法 135例功能性便秘患者随机分为3组,每组45例。A组给予口服莫沙比利5mg/次,3次/d,乳果糖10ml/次,3次/d;B组单用莫沙比利;C组单用乳果糖,疗程均为4周。记录患者服药前后大便间隔天数、大便性状的改变、排便困难程度改变及副反应。结果治疗4周后,3组有效率分别为93.33%、51.11%和82.22%;副作用发生率分别为4.44%、8.89%和8.89%。结论莫沙比利联合乳果糖治疗功能性便秘疗效优于两药单用而且副作用少。     

乳果糖联合莫沙必利治疗糖尿病便秘的临床研究

目的观察乳果糖联合莫沙必利治疗糖尿病患者便秘的临床效果与安全性。方法86例糖尿病合并便秘患者按随机数字表法随机分为观察组（30例）、莫沙必利组（27例）和乳果糖组（29例）。观察组患者给予乳果糖30ml／次,1次／d,待起效后改为10～20ml／（次·d）,以及莫沙必利5mg,3次／d,餐前30min服用;莫沙必利组患者仪给予莫沙必利治疗,乳果糖组患者仅给予乳果糖治疗,给药途径及用药方法同观察组。分别比较3组患者治疗3d及2周时便秘及伴随症状改善情况、不良反应。结果86例患者全部进入结果分析,无失访或退出者。治疗3d、2周后,观察组总有效率达73．3％（22／30）、96．7％（29／30）,均明显高于莫沙必利组[37．0％（10／27）、63．0％（17／27）]和乳果糖组[48．3％（14／29）、79．3％（23／29）],差异均有统计学意义（均P〈0．05）。观察组不良反应有腹胀加重3例、腹泻1例、腹痛2例;莫沙必利组腹痛4例,腹泻1例;乳果糖组腹胀2例,腹痛2例,无严重不良反应。观察组、莫沙必利组与乳果糖组3组不良反应发生率分别为20．0％（6／30）、18．5％（5／27）、13．8％（4／29）,组间比较差异无统计学意义（P〉0．05）。结论乳果糖联合莫沙比利治疗糖尿病患者便秘较单用乳果糖或者莫沙必利疗效好。     

The cost‐effectiveness of macrogol 3350 compared to lactulose in the treatment of adults suffering from chronic constipation in the UK

Background It is unknown whether macrogol 3350 (Movicol) affords the UK’s National Health Service (NHS) a cost‐effective addition to the current range of laxatives. Aim To estimate the cost‐effectiveness of macrogol 3350 compared with lactulose in the treatment of chronic constipation, from the perspective of the UK’s NHS. Methods A decision model depicting the management of chronic constipation was constructed using clinical outcomes and resource use values derived from patients suffering from chronic constipation in The Health Independent Network (THIN) database. The model was used to estimate the cost‐effectiveness of a GP prescribing macrogol 3350 instead of lactulose to treat adults ≥18 years of age suffering from chronic constipation. Results Sixty‐eight percent of patients given macrogol 3350 were successfully treated within 6 months after starting treatment compared to 60% of patients given lactulose.Patients’ health status at 6 months was estimated to be 0.458 and 0.454 quality‐adjusted life years (QALYs) in the macrogol 3350 and lactulose groups respectively. The total 6‐monthly NHS cost of initially treating patients with macrogol 3350 or lactulose was estimated to be £420 (US $688) and £419 (US $686) respectively. Hence, the cost per QALY gained with macrogol 3350 was estimated to be £250 (US $410). Conclusion Macrogol 3350 affords the NHS a cost‐effective addition to the range of laxatives available for this potentially resource‐intensive condition. Aliment Pharmacol Ther 31 , 302–312     

Long-term efficacy and cost-effectiveness of polyethylene glycol 3350 plus electrolytes in chronic constipation: a retrospective study in a disabled population

ABSTRACT

Objectives: The efficacy and safety of treatments for constipation in severely intellectually disabled patients and their associated cost-effectiveness are an underinvestigated area of clinical practice. Aiming to address this, the objectives of the study were to evaluate the efficacy and tolerability of polyethylene glycol 3350 plus electrolytes (Movicol; PEG+E) by comparing clinical data collected before and after its introduction to a stable population of residents of a mental health care, long-stay institution. The study also attempted an economic evaluation of the use of PEG+E in this setting.

Research design and methods: This was a retrospective study of 54/66 severely intellectually and physically disabled residents of a specialist unit at La Milétrie University Hospital, Poitiers, France, who suffered regularly from constipation. A total of 54 residents were treated with PEG+E (1–3 sachets a day) for 24 months. The number of stools, episodes of diarrhoea (defined as frequent stools, not necessarily watery), body weights and blood biochemistry were recorded. Data were compared with those recorded during the 21 months preceding the introduction of PEG+E for 16/54 residents who had been treated regularly with a range of other interventions for the relief of constipation. The monthly use and costs of laxatives, enemas and suppositories was obtained from hospital pharmacy records, and the total hospital costs before and after the introduction of PEG+E treatment was calculated.

Results: The mean (± standard deviation) number of stools per patient per month was significantly greater following the introduction of PEG+E (24.9 ± 6.3) compared to before its use (12.4 ± 3.4) (?p < 0.001). The mean (± standard deviation) monthly number of episodes of diarrhoea per patient before and after the introduction of PEG+E was 0.1 ± 0.1 and 6.3 ± 2.9, respectively (?p < 0.001). Treatment with PEG+E was not associated with adverse effects on body weight or blood biochemistry values. Introduction of PEG+E and its increasing use reduced the total hospital medical ward expenditure on laxatives from 3788 to 1767 Euros per month.

Conclusions: PEG+E is effective in the clinical management of constipation in an institutional setting. Furthermore, long-term intensive therapy with PEG+E was not associated with adverse effects on body weight or blood biochemistry values. Although the time periods over which the economic data and the efficacy and safety data were collected did not directly correspond, this study indicates that use of PEG+E in the management of constipation in people with severe intellectual disability may be cost-effective, reducing hospital laxative costs.     

六味安消胶囊与乳果糖口服液治疗老年功能性便秘的效果观察

目的对比六味安消胶囊与乳果糖口服液治疗老年功能性便秘的效果。方法选择本院老年功能性便秘患者46例,随机分为两组,其中六味安消胶囊组给予口服六味安消胶囊治疗,4粒／次,3次／d;乳果糖组给予乳果糖口服液治疗,10ml／次,3次／d。疗程为4周。结果六味安消胶囊组总有效率为91．3％,乳果糖组总有效率为86．9％,两组总有效率差异无统计学意义（P〈0．05）;两组均未出现明显不良反应。结论六味安消胶囊与乳果糖口服液治疗老年患者功能性便秘疗效明显且安全,均值得推荐。     

Cost-effectiveness comparison of current proton-pump inhibitors to treat gastro-oesophageal reflux disease in the UK

ABSTRACT

Objective: Gastro-oesophageal reflux disease (GORD) is a recurring condition with many patients requiring long-term maintenance therapy. Therefore initial choice of treatment has long-term cost implications. The aim was to compare the costs and effectiveness of treatment of GORD (unconfirmed by endoscopy) with seven proton pump inhibitors (PPIs: esomeprazole, lansoprazole (capsules and oro-dispersible tablets), omeprazole (generic and branded), pantoprazole and rabeprazole), over one year.

Design and methods: A treatment model was developed of 13 interconnected Markov models incorporating acute treatment of symptoms, long-term therapy and subsequent decisions to undertake endoscopy to confirm diagnosis. Patients were allowed to stop treatment or to receive maintenance treatment either continuously or on-demand depending on response to therapy. Long-term dosing schedule (high dose or step-down dose) was based on current market data. Efficacy of treatments was based on clinical trials and follow-up studies, while resource use patterns were determined by a panel of physicians.

Main outcome measures: The model predicts total expected annual costs, number of symptom-free days and quality-adjusted life-years (QALY).

Results: Generic omeprazole and rabeprazole dominated (i.e. cost less and resulted in more symptom-free days and higher QALY gains) the other PPIs. Rabeprazole had a favourable cost-effectiveness ratio of £3.42 per symptom-free day and £8308/quality-adjusted life-year gained when compared with generic omeprazole. Rabeprazole remained cost-effective independent of choice of maintenance treatment (i.e. proportion of patients remaining on continuous treatment versus on-demand treatment).

Conclusions: Economic models provide a useful framework to evaluate PPIs in realistic clinical scenarios. Our findings show that rabeprazole is cost-effective for the treatment of GORD.     

Cost-utility of somatropin (rDNA origin) in the treatment of growth hormone deficiency in children

ABSTRACT

Objective: The objective of this study was to generate estimates of cost-effectiveness/utility of somatropin (rDNA origin) in the treatment of growth hormone deficiency (GHD) in children

Methods: A decision-analytic model of the epidemiology and treatment of GHD in children was developed. Treatment of GHD was assessed in two hypothetical cohorts compared to no treatment – treatment with somatropin 0.030?mg/kg/day from ages 5 to 16 years, and treatment from ages 3 to 18 years. Costs (stated in 2005 US$) included those related to drug acquisition, endocrinologist consultations, and primary care office visits. Estimates of patient weight by age and sex were derived from published literature, as was the proportion of patients achieving normal height through somatropin treatment and pre/post-treatment patient utilities. Cost-effectiveness/utility was estimated over patients’ expected lifetimes, and was stated alternatively as discounted (3% per annum) US dollars per normal height year (NHY) gained, and cost per quality adjusted life-year (QALY) gained. Multivariate sensitivity analyses were conducted to ensure robustness of the model.

Results: The cost-effectiveness and cost-utility of treating children from ages 5 to 16 years with somatropin was estimated at approximately $8900 per NHY gained and $37?000 per QALY gained, respectively. Corresponding ratios pertaining to treatment of children from ages 3 to 18 years were $9300 per NHY gained and $42?600 per QALY gained. Findings were relatively insensitive to variation in most model parameters.

Conclusions: For both age cohorts, the cost-effectiveness/utility of somatropin in the treatment of GHD compares favorably to well-accepted threshold values. The use of somatropin represents reasonable value for money for the treatment of GHD in children.     

便秘方治疗慢性功能性便秘临床观察

目的:观察便秘方治疗慢性功能性便秘的临床疗效。方法:120例慢性功能性便必患者随机分为治疗组和对照组。对照组采用聚乙二醇电解质散剂治疗,治疗组采用我院自制便秘方治疗。结果:治疗组痊愈、显效、有效、无效及治疗总有效率分别为25%(15例)、58.33%(35例)、8.33%(5例)、8.33%(5例)及91.67%(55例),对照组痊愈、显效、有效、无效及治疗总有效率分别为8.33%(5例)、40%(24例)、30%(18例)、21.67%(13例)及78.33%(47例),组间比较差异显著(P<0.05),便秘方临床疗效优于聚乙二醇电解质散剂。结论:便秘方治疗慢性功能性便秘疗效优于聚乙二醇电解质散剂。     

聚乙二醇4000治疗老年人慢性功能性便秘

目的 :评价聚乙二醇 40 0 0对老年人慢性功能性便秘的疗效和安全性。方法 :60例年龄在(81±s 5)a的老年功能性便秘病人 ,分为 2组 ,共有 59例病人完成治疗 ,聚乙二醇组 2 9例给予聚乙二醇 40 0 0 ,1 0g,po,bid ;乳果糖组 30例 ,给以乳果糖 ,1 5mL ,po,bid ,疗程均为 2 1d。治疗后观察病人大便次数和大便形状 ,并观察腹胀、食欲不振、大便困难等症状缓解率。结果 :聚乙二醇组经治疗后排便困难发生率由 86 %下降至 34 % ,较治疗前有显著性下降 (P <0 .0 1 ) ,与乳果糖组比较 ,无统计学差异 (P >0 .0 5) ;且在有效病人中服药量小于乳果糖组 ,但 2组相比无统计学差异 ;聚乙二醇组治疗便秘的显效率和有效率分别为 52 %和 1 7% ,与乳果糖组相似 (P >0 .0 5) ;而不良反应发生率为 6 .9% ,与乳果糖组相近 (P >0 .0 5)。结论 :聚乙二醇 40 0 0能安全有效地治疗老年人慢性功能性便秘     

槐杞黄颗粒联合聚乙二醇4000散治疗儿童便秘疗效及对患儿肠道菌群、免疫功能的影响

目的 研究槐杞黄颗粒联合聚乙二醇4 000散治疗儿童便秘疗效及对患儿肠道菌群、免疫功能的影响。方法 选择2016年4月-2019年2月邢台市人民医院收治的便秘患儿96例,采用随机数表法分为对照组和观察组,每组各48例。对照组患儿分两次温水冲服聚乙二醇4000散,1.5 g/（kg·d）,并根据患儿粪便嵌塞情况逐渐减量。观察组患儿在对照组的基础上温水冲服槐杞黄颗粒,10 g/次,2次/d。2周为1个疗程,两组患儿均治疗2个疗程。观察两组患者的临床疗效,比较两组患儿治疗前后免疫功能、肠道菌群水平、临床症状评分、中医证候总分、生存质量评分（HRQOL）及不良反应发生情况。结果 治疗后,对照组总有效率为79.17%,低于试验组总有效率93.75%,差异有统计学意义（P<0.05）。治疗后,两组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平升高,CD8⁺水平降低（P<0.05）,其中观察组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平高于对照组,CD8⁺水平低于对照组,差异有统计学意义（P<0.05）。治疗后,两组肠道内双歧杆菌、乳酸杆菌水平升高,葡萄球菌、大肠杆菌水平降低（P<0.05）;其中观察组双歧杆菌、乳酸杆菌水平高于对照组,葡萄球菌、大肠杆菌水平低于对照组,差异有统计学意义（P<0.05）。治疗后,两组排便次数、排便难度、排便时间和大便性状等评分均降低（P<0.05）;其中观察组排便次数、排便难度、排便时间和大便性状评分低于对照组,差异有统计学意义（P<0.05）。治疗后,两组中医症候总分明显减少,HRQOL评分升高（P<0.05）,其中观察组中医症候总分低于对照组,HRQOL评分高于对照组,差异有统计学意义（P<0.05）。两组不良反应发生率无明显差异。结论 槐杞黄颗粒联合聚乙二醇4000散治疗便秘患儿,能够显著改善患儿便秘症状和生存质量,提高免疫功能,调节肠道内菌群水平,效果显著。     

Clinical and economic impact of using macrogol 3350 plus electrolytes in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction based on actual clinical practice in England and Wales

ABSTRACT

Objective: To estimate the clinical and economic impact of using macrogol 3350 plus electrolytes (macrogol 3350; Movicol; Movicol Paediatric Plain) in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction.

Methods: A chart review was undertaken to extract clinical outcomes and resource use from the case notes of a cohort of children aged 2–11 years with faecal impaction who initially received either macrogol 3350 (in an outpatient setting) or enemas and suppositories or manual evacuation for initial disimpaction. Five centres across England and Wales participated in the study. These data were used to inform a decision model which depicted the management of children during the disimpaction phase and for a period of 12 weeks following initial disimpaction. Unit resource costs at 2005/2006 prices were applied to the resource utilisation estimates within the model, enabling the incremental costs and consequences of using macrogol 3350 in an outpatient setting, compared to the other treatments, to be estimated.

Results: 112 patients treated with macrogol 3350, 101 who received enemas and suppositories and 11 who underwent a manual evacuation were eligible for analysis. Ninety-seven per cent of children treated with macrogol 3350 were successfully disimpacted within 5 days, compared to 73% of those who received enemas and suppositories and 89% of those who underwent a manual evacuation (?p < 0.001). There were no significant differences in reported adverse events between the different treatments for disimpaction, with the exception of vomiting which was significantly higher among those who underwent a manual evacuation (18% versus 2% with the other treatments; p < 0.01). There were no significant differences in the number of clinician outpatient visits between treatments. However, macrogol 3350-treated patients had significantly fewer hospital admissions than those who received the other interventions (0.1 versus 1.4 and 1.0 for enemas and suppositories and manual evacuation respectively; p < 0.05) and occupied fewer bed days. The total NHS cost of disimpaction and subsequent maintenance of children initially treated with macrogol 3350 was estimated to be £694 (95% CI: £496; £892). This compared with £2759 (95% CI: £1266; £4252) and £2333 (95% CI: £1609; £3058) for those who initially received enemas and suppositories or underwent a manual evacuation, respectively. Hence, using macrogol 3350 instead of enemas and suppositories and manual evacuation to disimpact the whole annual cohort of faecally impacted children aged 2–11 years in England could potentially reduce annual NHS expenditure on this condition by 59% (£5 million) and reduce the annual number of paediatric hospital admissions for this condition by 92% (4330).

Conclusion: Within the limitations of our model, macrogol 3350 affords the NHS a clinically effective and cost-effective treatment for the disimpaction of children suffering from faecal impaction compared to enemas and suppositories or a manual evacuation, and has the potential to release healthcare resources for alternative use within the system.     

曲美布汀联合聚乙二醇4000治疗老年人便秘型肠易激综合征

目的观察曲美布汀联合聚乙二醇4000治疗老年人便秘型肠易激综合征的疗效方法68例便秘型肠易激综合征老年患者,给予口服曲美布汀胶囊0.2 g,3次·d~(-1),聚乙二醇4000散利10 g,1次·d~(-1),疗程均为15 d。观察患者大便次数及腹痛、腹胀缓解程度。结果治疗后患者腹痛、腹胀及便秘等症状分级明显好转,与治疗前比较差异非常显著(均P<0.01),总有效率为93%。结论曲美布汀联合聚乙二醇4000治疗老年人便秘型肠易激综合征,疗效满意,不良反应少。     

生血宁片对老年贫血合并功能性便秘的治疗作用

目的探讨生血宁片对老年贫血合并功能性便秘的治疗效果。方法对老年贫血合并功能性便秘的患者应用生血宁片进行治疗,每日3次,每次0.5g,观察治疗前后便秘及贫血的改善情况。结果便秘症状痊愈86例,显效12例,无效8例,总有效率为92.5%,服药后4周各项贫血指标均有明显改善。结论生血宁片对贫血合并功能性便秘的老年患者有很好的疗效,特别是对便秘疗效明显,值得推广。     

三种药物治疗高龄老年人慢性功能性便秘的成本-效果分析

目的分析乳果糖口服溶液、聚乙二醇4000散和麻仁软胶囊治疗高龄老人功能性便秘的成本-效果。方法将258例高龄老人功能性便秘的患者随机分为三组,分别给予乳果糖口服溶液,每次15～30 mL,早餐后1次口服(乳果糖组);聚乙二醇4000散,每次20 g,早餐前冲服(聚乙二醇组)和麻仁软胶囊,每次1.2 g,早餐后1次口服(麻仁组),2周和4周后评价药物的疗效,4周后计算治疗成本,进行药物经济学评价。结果治疗2周和4周后乳果糖组总有效率明显高于聚乙二醇组和麻仁组,差异有显著意义(P<0.05、P<0.01)。乳果糖口服溶液、聚乙二醇4000散和麻仁软胶囊治疗高龄老人功能性便秘的成本分别为570.6、482.0和340.6元;成本-效果比分别为5.8、5.5和4.7。结论乳果糖口服溶液治疗高龄老年人功能性便秘效果最好,但成本-效果比略高于其他两药。在评价药物治疗成本时,必须考虑药物的疗效、疗程以及安全性。     

聚乙二醇4000治疗老年患者慢性功能性便秘的疗效分析

目的观察聚乙二醇4000治疗老年患者慢性功能性便秘的疗效和安全性。方法选择慢性功能性便秘老年患者72例,随机平分为治疗组和对照组。治疗组选用聚乙二醇4000治疗,每次10g,bid,疗程2周;对照组选用乳果糖治疗,每次15ml,bid。疗程2周。观察排便次数、性状的变化及伴随症状的情况。结果聚乙二醇4000和乳果糖均可使多数老年慢性功能性便秘患者的大便次数、大便性状及伴随症状恢复正常或缓解,总有效率分别为72．2％和67．7％,两组无显著性差异(P＞0．05),药物不良反应发生率分别为5．6％、11．1％,差异无显著性(P＞0．05)。结论聚乙二醇4000是一种治疗老年患者慢性功能性便秘有效而安全的药物。