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目的:观察抗反流治疗对胃-食管反流(GERD)所致支气管哮喘的效果。方法:选取经规范抗支气管哮喘治疗,症状无缓解或反复复发的哮喘58例,均符合支气管哮喘诊断标准,并经24h食管pH监测确诊存在GERD。在规范哮喘治疗(口服氨茶碱、β受体激动药、吸入皮质激素及抗感染等)基础上,加用抗GERD药物奥美拉唑和多潘立酮口服。疗程4周,比较治疗前后食管pH环境、临床症状及肺功能改善情况。结果:治疗后,24h食管内pH<4.0占总时间的百分比、直立位及卧位pH<4.0占总时间的百分比、反流次数、≥5min的反流次数及持续最长反流时间均显著或非常显著少(短)于治疗前(P<0.05,P<0.01);患者FEV1、PEF均显著增加(P<0.05);咳喘、胃灼热及反酸情况周平均日次数显著减少(P<0.05)。结论:对于经规范支气管哮喘治疗效果不理想的哮喘患者,应考虑存在GERD的可能,积极进行24h食管pH监测;对于确诊存在GERD者,联合给予抗反流治疗,以缓解症状,改善预后。
Objective: To observe the effect of anti-reflux therapy on bronchial asthma caused by gastroesophageal reflux (GERD). Methods: Fifty-eight asthmatic patients who were treated with standard anti-bronchial asthma, without symptoms or with recurrent symptoms were all eligible for the diagnostic criteria of bronchial asthma. The GERD was confirmed by 24h esophageal pH monitoring. In the regulation of asthma treatment (oral aminophylline, β-agonists, inhaled corticosteroids and anti-infection, etc.) based on the addition of anti-GERD drugs omeprazole and domperidone orally. Treatment for 4 weeks, before and after treatment esophageal pH environment, clinical symptoms and improvement of lung function. Results: After treatment, the percentage of total esophageal pH <4.0 in total time, the percentage of total time in standing position and lying position <4.0, the frequency of reflux, the number of reflux for ≥5 minutes and the longest continuous reflux time were all significantly (P <0.05, P <0.01). The FEV1 and PEF of patients were significantly increased (P <0.05), and the average number of weeks of asthma, heartburn and acid reflux decreased significantly (P <0.05, P < <0.05). CONCLUSIONS: For patients with asthma who do not have the desired therapeutic effect of bronchial asthma, the possibility of GERD should be considered and 24-hour esophageal pH monitoring should be actively carried out. Anti-reflux therapy should be given to patients with confirmed GERD to relieve symptoms and improve prognosis.