中西医结合治疗对胃食管反流病食道动力及酸反流的影响

目的: 探讨气滞胃痛颗粒和木香顺气丸联合奥美拉唑镁肠溶片及盐酸伊托必利片的治疗对胃食管反流病(GERD)食道动力及酸反流的影响. 方法: 90例GERD患者采用随机按数字表法分为西药组和观察组各45例.西药组服用奥美拉唑镁肠溶片,20 mg/次,早、晚各1次;盐酸伊托必利片,50 mg/次,3次/d.观察组在西药组治疗的基础上加服气滞胃痛颗粒,5 g/次,3次/d;木香顺气丸,6 g/次,3次/d.两组疗程均为8周.进行治疗前后反流性疾病问卷(RDQ)量表评分;进行治疗前后食管测压和24 h食管pH监测. 结果: 治疗后两组上食管括约肌(UES)和下食管括约肌(LES)静息压较治疗前增高,观察组增高更为显著(P<0.01),两组湿咽成功率较治疗前提高,观察组高于西药组(P<0.01);观察组酸反流总次数、酸反流>5 min的次数、总计pH<4的百分比、卧位pH<4的百分比、最长反流时间和DeMeester评分均较治疗前减少(P<0.01),治疗后观察组酸反流总次数和DeMeester评分少于西药组(P<0.01);观察组反流性疾病问卷(RDQ)量表烧心、反流、非心源性胸痛、反酸评分及总分均低于西药组(P<0.01). 结论: 中西医结合治疗能增强食管体部蠕动功能、改善食道动力及减少酸反流,从而减轻GERD临床症状,疗效优于单纯的西医治疗.

Influence on Esophageal Motility and Acid Reflux in Patients with Gastroesophageal Reflux Disease Using Integrated Traditional Chinese Medicine and Western Medicine Therapy

Objective: To discuss the influence of Qizhi Weitong granules and Muxiang Shunqi pills combined with omeprazole magnesium enteric-coated tablets and itopride hydrochloride tablets on esophageal motility and acid reflux in patients with gastroesophageal reflux disease (GERD). Method: Ninety GERD patients were randomly divided into western medicine group (45 cases) and observation group (45 cases) by random number table. Patients in western medicine group took 20 mg omeprazole magnesium enteric-coated tablets orally morning and night and 50 mg itopride hydrochloride tablets 3 times daily. Based on the treatment of western medicine group, patients in observation group added 5 g Qizhi Weitong particle 3 times daily, and 6 g Muxiang Shunqi pills 3 times daily. All patients in two groups received 8-week course of treatmen. Score of reflux disease questionnaire (RDQ) scale was recorded before and after the treatment. Esophageal manometry and 24 h esophageal pH monitoring were conducted. Result: The resting pressure of upper and lower esophageal sphincter in both groups were increased after treatment. Besides, the observation group obtained better results (P<0.01). Success rate of wet swallowing in both groups was increased as compared with that before, and the success rate in observation group was higher than that in western medicine group (P<0.01). The total number of acid reflux, the number of acid reflux>5 min, the percentage of total pH 4, the percentage of decubitus pH<4, the longest reflux time and DeMeester score in observation group were decreased after treatment (P<0.01). Besides, total number of acid reflux and DeMeester score in observation group were less than those in western medicine group (P<0.01). RDQ scale heartburn, reflux, non cardiac chest pain, anti acid score and total score in observation group were inferior to those in western medicine group (P<0.01). Conclusion: Integrated traditional Chinese medicine and western medicine therapy can strengthen function of esophageal peristalsis, improve esophageal motility, reduce acid reflux, and relieve GERD symptoms. The curative effect of this therapy is superior to using western medicine treatment alone.