10天序贯疗法联合健康教育对幽门螺杆菌感染根除失败患者的影响

摘要

目的：探讨10d序贯疗法联合健康教育对幽门螺杆菌感染根除失败患者补救治疗的效果,为选择合适的补救治疗措施提供依据。方法选择2012年至2014年四川大学华西医院消化内科就诊的Hp根除失败的患者102例,将患者按照随机数字表法分为2组,一组采用序贯疗法联合健康教育(试验组,n=51),一组采用标准四联疗法(对照组, n=51)。试验组：前5d口服奥美拉唑20mg+阿莫西林1000mg,2次/d,后5d口服奥美拉唑20mg+替硝唑500mg+克拉霉素500mg,2次/d；同时由医师及护士组成干预小组,对患者进行健康教育及随访。对照组：给予奥美拉唑20mg+胶体次枸橼酸铋钾220mg+阿莫西林1.0g+克拉霉素500mg,2次/d,总疗程7d。观察两组患者治疗总有效率、1个月后转阴率、Hp相关知识了解情况、不良反应。结果试验组患者失访2例,未按要求用药1例,最终共纳入48例患者；对照组失访1例,共纳入50例患者。治疗结束后,试验组患者总有效率为97.9%,高于对照组的84%,差异有统计学意义( P<0.05)。1个月后复查14 C-尿素呼气试验,试验组共转阴45例,转阴率为93.8%；对照组共转阴36例,转阴率为72%。两组患者相比差异有统计学意义(P<0.05)。试验组患者1个月后对Hp相关知识了解共43例,了解率为89.6%；对照组患者对Hp相关知识了解共16例,了解率为32%,两组患者相比差异有统计学意义(P<0.05)。试验组患者共4例患者出现不良反应,不良反应率为8.3%；对照组患者共4例患者出现不良反应,不良反应率为8%,两组患者不良反应相比差异无统计学意义(P>0.05)。结论10d序贯疗法联合健康教育可以作为幽门螺杆菌感染根除失败患者的补救治疗措施,更加能够加强患者的认识,切断感染途径,防止复发。%Objective To discuss the curative effect of 10-day sequential therapy combined with health education on pa-tients experienced Helicobacter pylori( Hp) eradication therapy failure. Methods 102 patients failed the helicobacter pylori eradi-cation therapy in the Department of Gastroenterology,West China Hospital from 2012 to 2014 were randomized into 2 groups,51 patients in each group,in accordance with the random number table. Patients in the treatment group were treated with omeprazole (20mg),amoxicillin(1000mg),twice a day for the first five days followed by omeprazole(20mg),tinidazole(500mg)and clarithro-mycin(500mg),two times a day in the last 5 days. In the mean time,the patients received health education and follow-up conduc-ted by intervention groups consisted of physicians and nurses. And for the control group,a 7-day course of standard quadruple ther-apy of omeprazole(20mg),colloidal bismuth potassium citrate(220mg),amoxicillin(1. 0g)and clarithromycin(500mg),two times a day,was administered. Compared the overall effective rate,negative conversion rate after a month,awareness rate of Hp-related knowledge and adverse effect rate in the two groups. Results 2 patients were lost to follow-up and 1 patient did not take drugs as required in the treatment group and 48 patients were included. And 1 patient in the control group was lost to follow-up and finally the control group enrolled 50 patients. When treatment finished,the overall effective rate in the treatment group was 97. 9%,signif-icantly higher than 84% in the control group. One month after treatment, 14 C-urea breath test was performed. 45 of the 48 patients (93. 8%)in the treatment group showed negative results,and only 36 of the 50 patients(72%)in the control group with their re-sults converted into negative. At the same time,43 patients(89. 6%)in the treatment group were aware of Hp-related knowledge, and the awareness rate was significantly higher than that(32%)in the control group. The adverse effect rate in the two groups did not demonstrate significant difference(P>0. 05). Conclusion 10-day sequential therapy combined with health education is an effective rescue therapy for first-line helicobacter pylori eradication failure.