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目的观察糖皮质激素在急性中重度放射性胃炎治疗中的应用及疗效。方法回顾性分析2012年1月至2015年4月因不能手术而接受单纯根治性放疗的51例胸下段食管癌患者的临床资料,根据治疗方法的不同分为对照组(n=20)和观察组(n=31)。对照组采用常规的抑酸、止吐及黏膜保护剂治疗,观察组在对照组治疗的基础上给予地塞米松短期冲击治疗(地塞米松磷酸钠10 mg静脉注射,1次/d,连续5 d;5 mg静脉注射,第6~10天;之后改用醋酸波尼松20 mg,口服,1次/d,第11~13天;10 mg口服,1次/d,第14~16天;最后5 mg,1次/d,连续口服5 d后停药)。观察时间从冲击治疗当天开始至口服激素停药后2个月,根据治疗23 d内症状改善与否及改善的程度,将疗效分为治愈、显效、有效、无效。结果治疗后观察组治愈、显效、有效、无效分别为19、9、3、0例,对照组分别为3、12、5、0例,观察组疗效显著优于对照组(Z=3.104,P<0.01);观察组治疗起效时间为(1.0±0.0)d,对照组起效时间为(7.0±1.3)d,观察组治疗起效明显早于对照组(P<0.01);观察组与对照组不良反应总发生率比较差异无统计学意义(6.5%vs 10.0%,P>0.05)。结论在具有强力抑酸护胃治疗的前提下,短期糖皮质激素冲击治疗急性中重度放射性胃炎可获得显著疗效,但尚需大样本、多中心的临床试验进一步明确。
Objective To observe the application and efficacy of glucocorticoid in the treatment of acute moderate-severe radioactive gastritis. Methods The clinical data of 51 patients with thoracic esophageal cancer who underwent radical surgery alone during January 2012 to April 2015 were retrospectively analyzed. According to the different treatment methods, they were divided into control group (n = 20) and observation group Group (n = 31). The control group was treated with conventional acid-suppressing, antiemetic and mucosal protective agents. The observation group was given dexamethasone short-term impact treatment (dexamethasone sodium phosphate 10 mg intravenously once a day for 5 consecutive days d; 5 mg intravenously, 6 to 10 days; later switched to 20 mg of prednisolone acetate, orally, 1 time / d, 11 to 13 days; 10 mg orally, 1 time / d, 14 to 16 days ; The last 5 mg, 1 time / d, continuous oral administration of 5 d after withdrawal). The observation time was from the day of impact treatment to 2 months after the withdrawal of oral hormones. According to the improvement of symptoms and the extent of improvement within 23 days of treatment, the curative effect was divided into cured, markedly effective, effective and ineffective. Results After treatment, the observation group was cured, markedly effective, effective and ineffective respectively 19,9,3,0 cases, the control group were 3,12,5,0 cases, the observation group was significantly better than the control group (Z = 3.104, P <0.01). The onset time of the observation group was (1.0 ± 0.0) d and the onset time of the control group was (7.0 ± 1.3) days. The onset of treatment in the observation group was earlier than that in the control group (P <0.01) The incidence of adverse reactions in the control group was no significant difference (6.5% vs 10.0%, P> 0.05). Conclusions With the treatment of strong acid suppression and stomach protection, short-term glucocorticoid shock treatment of acute moderate-to-severe radioactive gastritis can achieve a significant effect, but a large sample is still needed. The multicenter clinical trial is further clarified.