反流性咽喉炎的循证治疗

    Evidence-Based Treatment for Gastroesophageal Reflux Laryngitis

    • 摘要: 目的 借助循证医学的方法为1例胃食管反流引起的慢性反流性咽喉炎患者确定治疗方案。 方法 在充分评估患者情况后,提出临床问题,从Cochrane图书馆、PubMed、EMBASE(1990-2012年)进行检索,收集相关高质量证据进行评价,并结合医生经验及患者意愿制定治疗方案。结果共纳入随机对照试验9篇,Meta分析或系统评价2篇,非随机对照研究15篇。结果显示咽喉镜、食管测压及pH的监测在诊断反流性咽喉炎时比内镜更有价值。治疗应结合改变生活方式,戒烟酒,餐后2~3小时禁止平躺。选用质子泵抑制剂治疗的效果优于H2受体阻滞剂,同时应加用促胃动力药进行治疗,维持阶段应采用递减法,治疗6个月后反流相关的症状得到明显缓解。 结论 采用循证的方法,为患者制定合理的治疗方案,控制症状,提高患者生活质量。

       

      Abstract: Objective Evidence-based Methods were used to determine the individualized treatment plan for one reflux laryngitis patient. Methods The treatment strategy was developed after adequately evaluating the patient’s data based on valid evidences from Cochrane Library(Webpage 1990-2012), PubMed (1990-2012), EMBASE(1990-2012) and according to the patient’s preferences and physician clinical experience. Results A total of 9 RCTs, 15 CTs and 2 systematic reviews were identified to be suitable for the plan. The Results showed that mirror throat, esophageal manometry and pH monitoring more valuable than endoscopy for the diagnosis of reflux laryngitis. The treatment for the disease should be combined with lifestyle changes to avoid causative factors. The pharmacotherapy effects of PPI were better than H2RA, which should plus prokinetic drugs, were used in the decline method maintaining phase. After treatment for 6 months, the symptoms of reflux were significantly alleviated. Conclusion According to evidence-based methods, the treatment efficacy for reflux laryngitis patients has been improved by determining an individualized treatment plan.

       

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