雷贝拉唑和铝碳酸镁治疗胆囊切除术后伴胆汁反流的胃炎作用比较  

Comparative study on rabeprazole and hydrotalcite in treatment of patients with bile-reflux gastritis after cholecystectomy

作　　者：陈慧敏[1] 李晓波[1] 戈之铮[1] 

机构地区：[1]上海交通大学医学院附属仁济医院消化科上海市消化疾病研究所,200001

出　　处：《中华消化杂志》2010年第8期529-534,共6页Chinese Journal of Digestion

基　　金：上海市重点学科建设资助项目（Y0205）;杨森科学基金资助项目

摘　　要：目的观察雷贝拉唑、铝碳酸镁及两药联合对胆囊切除后伴有胆汁反流的胃炎的疗效。方法胆囊切除后，经24h胃内胆红素监测证实伴有胆汁反流的胃炎患者随机分为4组：空白对照组（n=30）、雷贝拉唑组（n=30，雷贝拉唑20mg，1次／d）、铝碳酸镁组（n=29，铝碳酸镁1．0g，3次／d）及联合用药组（n=31，雷贝拉唑＋铝碳酸镁，用法同上），疗程8周。观察各组患者腹痛、腹胀、烧心、口苦等症状改善情况，并于治疗结束后2周复查胃镜及组织学检查并再次进行24h胃内胆红素监测，进行胃镜下黏膜炎性反应程度（充血、水肿），组织学炎性反应程度（炎性反应、活动性）量化评分以及24h胆红素吸收值（ABS）3〉0．14总时间百分比、十二指肠内容物反流次数、长反流次数（〉5min）的变化比较。结果治疗后三组治疗组患者症状均有所改善，联合用药组内镜下水肿程度（2．11±0．77比1．50±0．67，P〈0．05）及HE染色组织学活动性评分（2．87±0．72比1．97±0．78，P〈0．05）均明显改善，长时间十二指肠内容物反流次数明显减少（18．26±1．80比9．70±1．20，P〈0．05），雷贝拉唑组和铝碳酸镁组上述指标治疗前后差异无统计学意义；三组治疗组患者ABS〉0．14的时间治疗前后差异均有统计学意义（P〈0．05）。结论雷贝拉唑和铝碳酸镁联用可有效治疗伴有胆汁反流的胃炎。Objective To compare the efficacy of rabeprazole and hydrotalcite in treatment of patients with bile-reflux gastritis after cholecystectomy. Methods Patients, who underwent cholecystectorny and were confirmed with bile reflux gastritis by 24 h gastric bilirubin monitoring, were enrolled in the study. Patients were randomly assigned into control group （n=30）, rabeprazole group （n = 30, 20 mg daily）, hydrotalcite group （n= 29,1. 0 g three times daily） and rabeprazole combined with hydrotalcite group （combination group, n=31） and treated for 8 weeks. Dyspeptic symptoms of abdominal pain, bloating, heartburn and bitter taste were observed. The endoscopic and histological examination were performed 2 weeks after treatment to evaluate the improvement of inflammation and histological activity. The 24 h bilirubin monitoring was used to assess the total per cent of bilirubin absorption （value of 0. 14 units or greater） time, the number of reflux episodes and the number of reflux episodes lasting longer than 5 min. Results The dyspeptic symptoms were relieved in three groups after treatment. However, the endoscopic oedema （2. 11±0. 77 vs 1. 50±0.67,P〈0.05） and the histological activity （2.87±0.72 vs 1.97±0.78,P〈0.05） as well as the immber of reflux episodes） 5 min （18.26±1.80 vs 9.70±1.20） were improved most significantly in combination group after treatment. There was no statistical difference in rabeprazole and hydrotaleite groups before and after treatment. Whereas the total percent time of bilirubin absorption value 〉0.14 decreased in three treatrnent groups after treatment （P〈0.05）. Conclusion Rabeprazole combined with hydrotalcite is effective in the treatment of patients with bile reflux gastritis after cholecysteetomy.

关 键 词：胃炎 十二指肠反流 雷贝拉唑 铝碳酸镁 

分 类 号：R686[医药卫生—骨科学]