抗反流治疗对胃食管反流病并咳嗽变异性哮喘的应用价值

目的探讨抗反流治疗对胃食管反流病并咳嗽变异性哮喘的临床应用价值。方法收集本院呼吸内科门诊胃食管反流合并咳嗽变异性哮喘患者50例,将其随机分为治疗组与对照组,对照组予布地奈德气雾剂0.2 mg,3次/d吸入,氨茶碱0.1 g,3次/d口服;治疗组在对照组治疗的基础上,加用莫沙必利5 mg,3次/d,泮托拉唑40 mg,1次/d口服。对两组患者夜间咳嗽、白天咳嗽行视觉模拟评分。结果治疗组治疗前、治疗4周后、治疗8周后的白天视觉模拟评分分别为（7.0±3.4）、（3.7±3.3）、（1.4±1.5）分,治疗4、8周后较治疗前降低,差异有统计学意义（P〈0.01）;对照组治疗前、治疗4周后、治疗8周后的白天视觉模拟评分分别为（6.9±3.6）、（5.1±3.4）、（2.8±1.9）分,治疗8周后较治疗前降低,差异有统计学意义（P〈0.01）。治疗组治疗前、治疗4周后、治疗8周后夜间视觉模拟评分分别为（5.1±2.9）、（3.2±2.6）、（1.2±1.6）分,治疗4、8周较治疗前降低,差异有统计学意义（P〈0.05,P〈0.01）;对照组治疗前、治疗4周后、治疗8周后的夜间视觉模拟评分分别为（5.2±3.1）、（3.7±3.0）、（2.6±2.2）分,治疗8周较治疗前降低,差异有统计学意义（P〈0.01）。治疗组治疗8周后白天及夜间视觉模拟评分均较对照组降低,差异有统计学意义（P〈0.05,P〈0.01）。治疗组治疗第4、8周嗳气、烧灼感较治疗前缓解率分别为61.5%（16/26）、88.5%（23/26）,对照组较治疗前无缓解,两组差异有统计学意义（P〈0.01）。治疗组及对照组治疗8周后支气管激发试验阴性率分别为46.2%（12/26）、25.0%（6/24）,差异无统计学意义（P〉0.05）。结论咳嗽变异性哮喘应积极寻找消化源性病因,抗反流治疗可以较快降低胃食管反流病并咳嗽变异性哮喘的咳嗽症状评分,减轻烧灼感、嗳气等症状。

The value of applying anti-reflux treatment for gastro-esophageal reflux and cough variant asthma

Objective To explore the clinical value of applying anti-reflux treatment for gastro-esophageal reflux and cough variant asthma.Methods 50 cases of patients with gastro-esophagea] reflux and cough variant asthma treated in the outpatient clinic of the Department of Respiratory Medicine of our hospital were randomly assigned to the treatment group and the control group.The control group was given 0.2 mg budesonide aerosol for three times a day and 0.1 g aminophylline with oral administration for three times a day.On the basis of above treatment,the treatment group was given 5 mg mosapride for three times a day and 40 mg pantoprazole with oral administration for once a day.Visual ana- logue scale was applied for daytime and nighttime cough.Results The daytime visual analogue scale of the treatment group before treatment,4 weeks after treatment and 8 weeks after treatment was （7.0＋3.4）,（3.7_＋3.3）,（1.4±1.5） respec- tively,with decreased daytime visual analogue scale at 4 weeks and 8 weeks after treatment than that before treatment, with statistical difference （P〈0.01）.The daytime visual analogue scale of the control group before treatment,4 weeks after treatment and 8 weeks after treatment was （6.9±3.6）,（5.1±3.4） and （2.8＋1.9） respectively,with decreased daytime visual analogue scale at 8 weeks after treatment than that before treatment,with statistical difference （P〈O.01）.The nighttime visual analogue scale of the treatment group before treatment,4 weeks after treatment and 8 weeks after treatment was （5.1±2.9）,（3.2＋2.6） and （1.2＋1.6） respectively,with decreased nighttime visual analogue scale at 4 weeks and 8 weeks after treatment than that before treatment,with statistical difference （P〈0.OS,P〈0.01）.The nighttime visual analogue scale of the control group before treatment,4 weeks after treatment and 8 weeks after treatment was （5.2±3.1）,（3.7±3.0）,（2.6± 2.2） respectively,with decreased nighttime visual analogue scale at 8 weeks after treatment than that before treatment, with statistical difference （P〈0.01）.The treatment group had lower daytime and nighttime visual analogue scale than that of the control group at 8 weeks after treatment,with statistical difference （P〈0.05,P〈0.01）.The percentage of eructation and heartburn remission in the treatment group was 61.5% （16/26） at 4 weeks after treatment and 88.5% （23/26） at 8 weeks after treatment compared with before treatment,but the control group had no remission,with statistical difference between the two groups （P〈0.01）.The negative rate of bronchial provocation test for the treatment group and control group at 8 weeks after treatment was 46.2% （12/26） and 25.0% （6/24） respectively,without statistical difference （P〉0.05）. Conclusion It is suggested to actively explore digestive pathogens for cough variant asthma.Anti-reflux treatment can quickly reduce symptom scaling score on gastro-esophageal reflux and cough variant asthma and alleviate eructation, heartburn and other symptoms.