摘要
目的探讨同步化经皮电针(TEA)联合腹式深呼吸训练(ADBT)治疗难治性胃食管反流病(refractory gastroesophageal reflux disease,r GERD)的疗效及其对相关血清神经递质Ach,NO含量的影响。方法将确诊的21例r GERD患者随机分为三组,A组口服埃索美拉唑20mg,bid,B组予以埃索美拉唑20mg,bid,同时予以TEA,qd,及配合ADBT,C组予以埃索美拉唑20mg,bid,配合ADBT同时予以假性电针治疗(Sham-TEA),三组4周治疗前后分别评价反流症状评分,食管测压,24h p H监测,应用ELASA方法检测血清乙酰胆碱(Ach),一氧化氮(NO)含量。结果 4周治疗前后比较,三组在反流症状评分,De Meester评分,Ach,NO含量,均P<0.05;LES压力,A组无明显差异P>0.05,但B组,C组差异有统计学意义。通过组间相互比较,B组反流症状评分较C组明显降低(1.57±0.53vs2.86±1.21,P=0.018)。C组反流症状评分较A组有所降低(2.86±1.21vs3.86±2.27,P=0.182),差异没有统计学意义。治疗后B组LES压力较C组升高更显著(26.14±7.06vs17.57±5.13,P=0.025)。C组LES压力较A组也明显升高(17.57±5.13vs13.29±5.74,P=0.003)。治疗后De Meester评分B组明显低于A组(11.17±3.29vs24.92±10.43,P=0.012),B组也明显低于C组(11.17±3.29vs15.19±1.95,P=0.019),C组明显低于A组(15.19±1.95vs24.92±10.43,P=0.032)。治疗后C组Ach含量较A组明显升高(71.68±4.84vs64.04±7.48,P=0.045);B组Ach含量也较A组明显升高(74.13±6.92vs64.04±7.48,P=0.022),C组NO含量较A组明显下降(81.65±16.40vs103.86±16.61,P=0.027);B组NO含量较A组明显降低(73.33±20.33vs103.86±16.61,P=0.01)。治疗后B组较C组NO含量也有所下降,但差异不明显,P>0.05。结论同步化TEA+ADBT治疗GERD能有效改善反流症状,提高LES压力,减少食管酸反流,可能与其调控相关神经递质NO,Ach的释放有关。
Objective To investigate the effect of Synchronizing transcutaneous electroacupuncture（ TEA） combined with abdominal deep breathing training（ ADBT） on（ refractory gastroesophageal reflux disease,r GERD） and serum related neurotransmitter acetylcholine（ Ach）,nitric oxide（ NO）. Methods In the outpatient and ward of Gastroenterology,Affiliated Provincial Hospital,Anhui Medical University from Aug,2016 to Feb,2017,Twenty-one patients with r GERD were randomly divided into three groups. Group A was treated with esomeprazole 20 mg bid. Group B received esomeprazole 20 mg bid at the same time,Electroacupuncture treatment at the same time with abdominal deep breathing training,group C to esomeprazole 20 mg bid,with deep breathing at the same time to be comfortable electroacupuncture treatment（ pseudo-electroacupuncture stimulation,acupuncture points to avoid the acupuncture points 2cm）. Three groups of patients were evaluated before and after treatment for 4 weeks,reflux symptom score,esophageal manometry,24 h p H monitoring,ELASA assay was used to detect serum Ach,NO content. Results There were statistical significancein reflux symptoms score,De Meester score,leverls of Ach and NO among the three groups between before and after 4 weeks oftreatment,P 0. 05,except LESP changes in A group had no statistical significance（ P〈0. 05）,but that of B group,C group had significant difference between before and after 4 weeks oftreatment. after 4 weeks of treatment,reflux symptom score in group B was significantly lower than that in group C（ 1. 57 ± 0. 53vs2. 86 ± 1. 21,P =0. 018）,reflux symptom score of group C was a little lower than that of group A（ 2. 86 ± 1. 21vs3. 86 ± 2. 27,P = 0. 182）; The LESP in group B was significantly higher than that in group C（ 26. 14 ± 7. 06 vs 17. 57 ± 5. 13,P = 0. 025）,The LESP in group C was more higher than that in group A（ 17. 57 ± 5. 13vs13. 29 ± 5. 74,P = 0. 003）. The De Meester score of group B was more smaller than that of group A（ 11. 17 ± 3. 29 vs 24. 92 ± 10. 43,P = 0. 012）,the De Meester score of group B was a lot smaller than that of group C（ 11. 17 ± 3. 29vs15. 19 ± 1. 95,P = 0. 019）,and the De Meester score of group C was more smaller than that of group A（ 15. 19 ± 1. 95 vs 24. 92 ± 10. 43,P = 0. 032）. Ach level in group C was significantly higher than that in group A（ 71. 68 ± 4. 84vs64. 04 ± 7. 48,P = 0. 045）,Ach content in group B was more higher than that in group A（ 74. 13± 6. 92 vs 64. 04 ± 7. 48,P = 0. 022）; NO level in group C was significantly lower than that in group A（ 81. 65 ± 16. 40 vs103. 86 ± 16. 61,P = 0. 027）,NO level in B group was more lower than group A（ 73. 33 ± 20. 33vs103. 86 ± 16. 61,P =0. 001）,There was no significant difference in the level of NO between group B and group C（ 73. 33 ± 20. 33vs81. 65 ± 16. 40,P 0. 05）.Conclusion Synchronizing TEA combined with ADBT in the treatment of GERD can effectively improve the reflux symptoms,increase LES pressure,reduce esophageal acid reflux,these maybe related to neural regulation of neurotransmitter NO,ACH release.
出处
《时珍国医国药》
CAS
CSCD
北大核心
2017年第8期2032-2035,共4页
Lishizhen Medicine and Materia Medica Research
基金
安徽省对外科技合作计划项目(No.1604b0602021)
