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目的借助循证医学方法为1例初诊胃食管反流性疾病患者确定治疗方案。方法在充分评估患者情况后,按照PICO原则提出临床问题并转化,计算机检索Cochrane图书馆(1990～2010)、PubMed(1990～2010)、Embase(1990～2010),收集相关高质量证据进行评价,并结合医生经验及患者愿望制定治疗方案。结果共纳入RCT 17篇,Meta分析/系统评价10篇。结果显示,选用质子泵抑制剂(PPI)治疗的效果优于H2受体拮抗剂,同时应加用促胃动力药。长期使用PPI时伴有幽门螺旋杆菌(HP)感染者需进行HP根除治疗。若需手术治疗,腹腔镜下胃底折叠术治疗效果较佳。根据以上证据并结合患者意愿,对该例患者采用一般性治疗结合埃索美拉唑伴西沙比利治疗;又因长期维持治疗过程中患者存在HP感染,故同时进行抗HP药物治疗。治疗6个月后,患者胃食管反流相关症状得到明显缓解。结论 PPI加用促胃动力药,以及在长期PPI治疗中如存在HP感染时联合HP根除治疗,可有效提高疗效和患者生活质量,但远期效果仍需进一步观察。
Objective To establish a treatment regimen for 1 case of newly diagnosed gastroesophageal reflux disease by means of evidence-based medicine. Methods After fully assessing the condition of patients, clinical problems were raised and transformed according to the principle of PICO. The Cochrane Library (1990-2010), PubMed (1990-2010) and Embase (1990-2010) were searched by computer. High quality evidence was collected for evaluation. And combined with the experience of doctors and the wishes of patients to develop treatment options. Results A total of 17 RCTs were included and 10 Meta-analysis / systematic reviews. The results show that the use of proton pump inhibitor (PPI) treatment is superior to H2 receptor antagonist, should also be used to promote gastric motility drug. Long-term use of PPI accompanied by Helicobacter pylori (HP) infection required HP eradication therapy. For surgical treatment, laparoscopic fundoplication better. Based on the above evidence and in accordance with the patient’s wishes, the patients were treated with esomeprazole and cisapride in combination with general treatment. In the long-term maintenance therapy, patients were also infected with HP, so anti-HP drugs were also administered. After 6 months of treatment, patients with gastroesophageal reflux related symptoms were significantly alleviated. Conclusions The combination of PPI plus gastric motility agent and long-term PPI treatment in the presence of HP infection combined with HP eradication therapy can effectively improve the efficacy and quality of life of patients, but the long-term effect needs further observation.