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作 者:陈淑洁[1] 李耿心[1] 王良静[1] 孙蕾民[1] 姒健敏[1]
机构地区:[1]浙江大学邵逸夫临床医学研究所胃肠病研究室,浙江省杭州市310016
出 处:《世界华人消化杂志》2004年第4期920-923,共4页World Chinese Journal of Digestology
摘 要:目的:采用SF-36生活质量和临床症状综合评价不同疗法对肠易激综合征(IBS)患者的疗效. 方法:2001-01/2002-01消化科门诊符合罗马Ⅱ标准的IBS 患者172例,按排便习惯分为便秘为主型、腹泻为主型和腹泻便秘交替型,分别接受一种方案治疗,疗程为8wk.方案A:匹维溴胺(100mg,3次/d);方案B:匹维溴胺(100 mg, 3次/d)+多虑平(25mg,晚服);方案C:安慰剂对照组.分别记录治疗前后患者SF-36生活质量评分和症状积分. 结果:A方案症状显效率和总有效率分别为40.5%和73.0%: B方案分别为65.4%和88.5%;C方案分别为30.5%和47.9%. A,B方案总有效率均显著高于C方案(P=0.046和0.002), B方案与A,C方案显效率均有显著差异(P=0.045和0.015). A,B方案对生活质量的改善优于C方案,以B方案对各个纬度的生活质量改善最为明显.B方案治疗后,躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)和精神健康(MH)维度的积分有显著提高(P<0.05),且患者的生理功能(PF)、生理职能(RP)、总体健康(GH)、活力(VT)、情感职能(RE)和精神健康(MH)6个维度的生活质量甚至接近抗州市普通人群的生活质量(P>0.05).三种不同亚型患者症状总有效率、显效率均无显著的统计学差异(P>0.05).症状疗效和生活质量改善呈一定的相关性,但相关无统计学意义(P>0.05). 结论:综合SF-36生活质量标准和症状疗效,可全面评价IBS疗效.联合匹维溴胺和抗抑郁药对改善患者的生活质量和IBS症状疗效最佳.AIM: To evaluate clinical symptoms, quality of life (QOL) outcomes in patients with irritable bowel syndrome (IBS) receiving different therapies. METHODS: 172 Roma II positive-IBS patients were assigned to 8 weeks of different therapies with Group A: pinaverium bromide (100 mg three times daily), Group B: pinaverium bromide (100 mg three times daily) plus doxepin (25 mg once daily) or Group C: placebo. Main outcomes assessment included a Chinese version of the SF-36 Health Survey Scales and symptomatic scores at baseline and 8 weeks. RESULTS: Symptom relief was achieved by 40.5%, 65.4% and 30.5% in groups A, B and C respectively. The total symptom improvement rate was 73.0%, 88.5% and 47.9% respectively. Compared with group C, the total symptom improvement rate in groups A and B had significant improvement (P =0.046 and 0.002 respectively). More group B patients noted symptom relief than groups A and C (P=0.045 and 0.015 respectively). Compared with group C, QOL in groups A and B had a striking improvement. Patients in group B noted more scales of SF-36 improvement. The scores of BP, GH, VT, SF and MH scales had significant improvement in group B, and the level of PF, RP, GH, VT, RE and MH were comparable with general population in Hangzhou (P >0.05). There was no significant difference of symptoms relief rate in three subgroups of IBS (P>0.05). There was not a significant correlation between symptomatic treatment and QOL improvement (P >0.05). CONCLUSION: SF-36 quality of life and symptom analysis should be recommended to evaluate the effectiveness of IBS. Pinaverium bromide combined with doxepin can significantly improve symptoms and QOL, which is effective in the treatment of IBS.
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