协和医学杂志

2015, v.6(02) 106-109

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饮热水联合硝酸异山梨醇酯对贲门失弛缓的治疗作用
Efficacy of Hot Water Drinking Combined with Isosorbide Dinitrate Therapy in Achalasia

臧凤莉;王智凤;柯美云;方秀才;孙晓红;
ZANG Feng-li;WANG Zhi-feng;KE Mei-yun;FANG Xiu-cai;SUN Xiao-hong;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;Department of Gastroenterology,The First Affiliated Hospital of Harbin Medical University;

摘要(Abstract):

目的探讨饮热水、含服硝酸异山梨醇酯及两者联合对贲门失弛缓是否具有治疗作用。方法顺序纳入2012年10月至2013年5月在北京协和医院消化内科门诊就诊的初治贲门失弛缓患者,随机分为两组,A组为饮水-联合药物治疗组,20例;B组为药物-联合饮水治疗组,22例,疗程4周。A组患者第1周仅予饮水治疗,第2~4周饮水联合药物治疗;B组第1周仅予药物治疗,第2~4周药物联合饮水治疗。所有纳入患者于基线期(治疗前2周)、治疗1周及治疗4周均进行临床症状评估,于基线期和治疗4周行食管动力监测及食管造影检查。结果最终41例患者纳入分析,其中A组19例,B组22例。两组患者性别、年龄及病程差异无统计学意义(P>0.05)。与基线期比较,A组治疗1周和治疗4周症状明显改善(P<0.05),且治疗4周症状改善明显优于治疗1周(P<0.05);与基线期比较,B组治疗4周症状明显改善(P<0.05);A组和B组之间症状积分比较差异无统计学意义(P>0.05)。与基线期比较,两组患者治疗4周下食管括约肌压力(lower esophageal sphincter pressure,LESP)和吞咽时下食管括约肌综合松弛压(integrated relaxation pressure,IRP)无明显降低(P>0.05);然而基线期和治疗4周,饮热水或药物干预后LESP及IRP较干预前明显降低(P<0.05)。与基线期比较,两组患者治疗4周食管宽度无明显变化(P>0.05)。结论饮水或药物干预通过短暂降低下食管括约肌压力和提高下食管括约肌松弛功能改善临床症状,两者联合干预效果更佳,但饮水、药物或联合干预不能持续改善下食管括约肌压力或松弛功能。饮水联合药物为不能耐受或不接受有创治疗及有创治疗后复发的患者提供一个可供选择的保守治疗方法。
Objective To evaluate the efficacy of hot water drinking,isosorbide dinitrate and combination of both in achalasia. Methods The patients with untreated achalasia admitted to Peking Union Medical College Hospital in the period of October 2012 to May 2013 were enrolled and randomly divided into group A( hot water drinking and combined therapy) and group B( isosorbide dinitrate and combined therapy). Patients in group A received hot water drinking only during the first week,then combined with isosorbide dinitrate from the second to the fourth week. Patients in group B received isosorbide dinitrate only during the first week,then combined with hot water drinking from the second to the fourth week. Clinical symptoms were evaluated at baseline( 2 weeks before treatment) as well as after 1-week and 4-week treatment. High-resolution manometry and X-ray barium esophagram were evaluated at both baseline and after 4-week treatment. Results A total of 41 patients were included in this study,19 in group A and 22 in group B. There was no significant difference in gender,age andcourse of disease between the two groups( P > 0. 05). Compared with baseline,symptoms were significantly alleviated after 1-week treatment and after 4-week treatment in group A( P < 0. 05),and symptoms were significantly mitigated after 4-week treatment than after 1-week treatment( P < 0. 05). Compared with baseline,symptoms were significantly alleviated after 4-week treatment in group B( P < 0. 05). There was no difference in scales of symptoms between the two groups( P > 0. 05). Compared with baseline,there was no significant reduction in lower esophageal sphincter pressure( LESP) and integrated relaxation pressure( IRP) after 4-week treatment in both groups( P > 0. 05). However,at both baseline and after 4-week treatment,LESP and IRP were significantly decreased after hot water drinking or sublingual isosorbide dinitrate compared with pre-intervention levels in both groups( P < 0. 05). There was no change in the width of the esophagus after 4-week treatment in both groups( P > 0. 05). Conclusions Hot water drinking or sublingual isosorbide dinitrate could alleviate clinical symptoms by temporarily decreasing LESP and IPR,which could be amplified by the combination of these two treatments,but the effect is not sustained. Hot water drinking combined with sublingual isosorbide dinitrate provides an option of conservative therapy for those intolerant to or relapsing after invasive treatment.

关键词(KeyWords): 贲门失弛缓;下食管括约肌;综合松弛压;饮热水;硝酸酯类药物
achalasia;lower esophageal sphincter;integrated relaxation pressure;hot water drinking;nitrates

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作者(Author): 臧凤莉;王智凤;柯美云;方秀才;孙晓红;
ZANG Feng-li;WANG Zhi-feng;KE Mei-yun;FANG Xiu-cai;SUN Xiao-hong;Department of Gastroenterology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;Department of Gastroenterology,The First Affiliated Hospital of Harbin Medical University;

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