老年胃食管反流病患者的心理状况和生活质量

目的探讨老年胃食管反流病患者的心理状况和生活质量状况。方法以国内通用的GERD临床诊断标准:RDQ总积分≥12分为依据,共入组符合诊断标准的GERD患者300例,其中老年组180例(年龄≥60岁),非老年组120例(年龄<60岁),与此同时纳入正常对照组100例。以Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)调查GERD患者的心理状况,以中文版SF-36生存质量量表对GERD患者的生活质量情况进行评估。结果老年GERD患者的SAS和SDS评分明显高于正常对照组,差异有统计学意义(P<0.05);SF-36评分明显低于正常对照组,差异有统计学意义(P<0.05)。结论老年人比较容易罹患GERD,患病后心理健康状况更容易受到影响,生活质量的下降也较为明显。     

老年胃食管反流病患者临床特征分析

目的 探讨老年胃食管反流病(GERD)患者的临床特征,为临床诊断、治疗提供帮助.方法 根据GERD蒙特利尔的标准、中国胃食管反流病共识意见等,将GERD患者分为老年组(年龄≥65岁)与中青年组(年龄＜65岁);通过问卷调查,分析2组GERD患者的食管裂孔疝(HH)、食管炎(洛杉矶标准)、临床症状(反流、烧心等)、生活质量.结果 两组性别比差异无统计学意义(P＞0.05).与中青年GERD患者比较:老年患者重度食管炎(LC级+LD级)比例高(P＜0.05);典型反酸、烧心症状轻(P＜0.05),食管外症状发生率高(P＜0.05);但HH发生率差异无统计学意义(P＞0.05).老年患者生理功能、总体健康、活力、社会功能、精神健康、躯体生理健康总评和精神心理健康总评积分与年轻组差异无统计学意义(P＞0.05),仅生理职能、躯体疼痛、情感职能积分较中青年组高(P＜0.05).结论 老年GERD患者典型反流症状(反食、烧心)较少见,易发生重度食管炎,但老年GERD患者生活质量无明显下降.     

老年胃食管反流病患者临床特征分析

Objective To analyze clinical characteristics of gastroesophageal reflux disease(GERD) in aged patients for improvement of diagnosis and treatemcnt. Methods The reflux disease questionnaire was performed in patients diagnosed as GERD based on Montreal definition and classification as well as Rome Ⅲ criteria.All patients were divided into elderly group (≥65 years) and control group(＜65 years). The incidence of hita[ hernia (HH), the frequencies of esophagitis (based on Los Angeles classification), clinical features, and quality of life were compared between two groups. Results There was no difference between two groups in male/female ratio and morbidity of HH(P＞0.05). In comparison with control group, the frequency of esophagitis graded as LC or LD increased and extra-esophageal symptoms were higher in elderly group (P＜ 0.05), but the lower typical symptoms (heartburn and regurgitation) were seen in the elderly group(P＜0.05). The scores of role physical, bodily pain and role emotional were higher in elderly group than those in control group (P＜0.05). There was no significant differences between two groups in physical function, vitality,social functioning, mental health, and general health. Conclusion The elderly GERD patients often have lower score of typical reflux symptoms (heartburn and regurgitation) and high incidence of severer esophagitis, but their quality of life is not significantly influenced.     

老年胃食管反流病患者临床特征分析

Objective To analyze clinical characteristics of gastroesophageal reflux disease(GERD) in aged patients for improvement of diagnosis and treatemcnt. Methods The reflux disease questionnaire was performed in patients diagnosed as GERD based on Montreal definition and classification as well as Rome Ⅲ criteria.All patients were divided into elderly group (≥65 years) and control group(＜65 years). The incidence of hita[ hernia (HH), the frequencies of esophagitis (based on Los Angeles classification), clinical features, and quality of life were compared between two groups. Results There was no difference between two groups in male/female ratio and morbidity of HH(P＞0.05). In comparison with control group, the frequency of esophagitis graded as LC or LD increased and extra-esophageal symptoms were higher in elderly group (P＜ 0.05), but the lower typical symptoms (heartburn and regurgitation) were seen in the elderly group(P＜0.05). The scores of role physical, bodily pain and role emotional were higher in elderly group than those in control group (P＜0.05). There was no significant differences between two groups in physical function, vitality,social functioning, mental health, and general health. Conclusion The elderly GERD patients often have lower score of typical reflux symptoms (heartburn and regurgitation) and high incidence of severer esophagitis, but their quality of life is not significantly influenced.     

胃食管反流病患者生活质量调查187例

目的:调查消化门诊人群胃食管反流病(gastroesophageal reflux disease,GERD)生活质量状况.方法:针对安徽铜陵三家市级医院2008-06/08消化内科门诊连续就诊人群,根据国内通用的GERD临床诊断标准(RDQ总积分≥12分)和洛杉矶反流性食管炎(RE)内镜诊断标准进行GERD调查和诊断,采用中文版SF-36生存质量量表进行GERD患者生活质量状况地评估.所有调查资料使用Epi Data 3.0软件建立数据库,利用SPSS13.0做统计学分析.根据数据的分布特征,分别采用X2检验、非参数检验、两样本t检验.结果:三家市级医院消化内科门诊7 352例连续就诊患者中共调查诊断出GERD 199例.187例GERD患者实际参与了生活质量状况的调查,选取了374例同年龄同性别的正常健康人群进行了病例对照研究.结果显示,GERD病例组8个纬度生活质量评分、SF-36量表总分均明显低于健康对照组,有显著性差异(P<0.05).非糜烂性反流病(nonerosive reflux disease,NERD)组7个纬度生活质量评分、SF-36量表总分均明显低于反流性食管炎(reflux esophagitis,RE)组患者,有显著性差异(P<0.05).无论NERD或RE组女性患者生活质量量表总分均明显低于男性,有显著性差异(P<0.05).结论:GERD患者生活质量较正常健康人群明显下降;在NERD、女性患者中更为突出.精神心理因素可能在GERD发病中起到一定作用.     

反流性食管炎和非糜烂性反流病患者症状谱、生活质量和精神心理状态调查

背景：胃食管反流病（GERD）包括非糜烂性反流病（NERD）、反流性食管炎（RE）和Barrett食管（BE），其发病机制可能有所不同。目的：分析比较NERD和RE患者的人口学特征和临床特点，为探讨其发病机制和有效治疗提供依据。方法：对连续入组的278例GERD患者进行问卷调查，内容包括一般人口学资料、胃食管反流以及相关症状评分、食管外症状、重叠症状、生活质量评价和精神心理状态评价。结果：NERD和RE分别占GERD的60．8％和37．1％；与RE组相比，NERD患者以女性多见（P〈0．05），平均年龄较轻（R〈0．05）。胃食管反流症状评分在两组患者间无显著差异，但RE组烧心频率较NERD组高（P〈0．05），而NERD组胸骨后疼痛更突出，反食症状较轻。两组患者的食管外症状、重叠症状发生率无显著差异。NERD组患者生活质量下降更明显。NERD组患者合并精神心理异常的比例显著高于RE组（P〈0．05），且抑郁评分高。结论：本组资料中大部分GERD患者为NERD，NERD和RE的反流以及相关症状谱无显著差异。但NERD患者常合并精神心理异常、生活质量下降，提示精神心理因素在NERD的发病中可能起重要作用。     

雷贝拉唑对胃食管反流病患者生活质量的影响

目的比较反流性食管炎(RE)和非糜烂性胃食管反流病(NERD)患者在雷贝拉唑治疗后生活质量的变化。方法2002年12月至2003年6月在国内进行了多中心观察雷贝拉唑(10mg,每天2次口服)8周治疗RE和NERD患者的疗效。共入选RE患者74例和NERD患者37例。治疗前后采用问卷调查方式了解生活质量,问卷包括胃食管反流病-生活质量问卷量表(GERD-HRQL)和SF-36健康量表。结果(1)治疗后所有患者症状改善均为显效,RE患者糜烂愈合率达94.6%。(2)RE患者在SF-36健康量表中7个维度有明显改善,与治疗前比较差异有统计学意义(P<0.05)。NERD患者仅在总体健康和活力2个维度有明显改善(P<0.05)。(3)RE和NERD两组比较,治疗前在SF-36健康量表中NERD患者在活力、躯体疼痛和总体健康3个维度上低于RE患者;治疗后RE患者6个维度值高于NERD患者(P<0.05),GERD-HRQL评分也明显低于NERD组。结论有效抑酸治疗可以理想地控制GERD患者的症状,但是NERD患者生活质量的改善不如RE患者,说明NERD患者的发病是多因素的,在治疗上更应强调综合整体治疗。     

胃食管反流病并功能性消化不良患者临床反流症状及生活质量的特点

[目的]探讨反流性食管炎（RE）和非糜烂性胃食管反流病（NERD）合并功能性消化不良（FD）患者反流症状及生活质量特点。[方法]该研究为多中心临床研究,在济南市的三家医院同期入选RE并FD 35例,NERD并FD73例。均符合内镜下RE的诊断标准,无RE者则为24 h食管pH监测阳性的NERD。进行反流症状及生活质量问卷调查并记录积分,然后对上述资料进行统计比较分析。[结果]①胃食管反流病（GERD）和FD病因尚不清楚,但症状可互相重叠。②NERD并FD临床反流症状积分（13.8±2.2）分,患者尽管没有可见的食管糜烂,但比RE并FD[（10.5±1.9）分]患者重（P〈0.01）,NERD并FD与RE并FD比较,在活力、躯体疼痛和总体健康3个维度上前者低于后者（P〈0.01）,余维度无统计学意义。[结论]①GERD和FD病因可能具有共同的神经胃肠病学基础。②NERD并FD患者反流症状严重,可能与NERD患者食管内脏高敏感性有关,对生活质量影响更大。     

埃索美拉唑对胃食管反流病患者症状和生活质量的影响

目的:探讨埃索美拉唑对胃食管反流病(GERD)患者症状和生活质量的影响.方法:采用前瞻、随机、阳性对照研究,将经内镜或24 h食管pH监测明确诊断的78例GERD患者随机分为标准剂量的埃索美拉唑(20 mg,2次/d,po)组和加倍剂量的奥美拉唑(20 mg,2次/d,po)组,每组39例.2组分别治疗8 wk,比较2组症状控制、RE内镜下有效率和愈合率、生活质量等区别.结果:共76例患者完成试验.埃索美拉唑组和奥美拉唑组各有1例RE因违反试验方案退出.4 wk和8 wk两组症状总积分治疗后均明显下降,但两组间差异无统计学意义.埃索美拉唑组和奥美拉唑组使NERD症状积分下降程度不如RE患者,但埃索美拉唑组使NERD患者症状积分下降优于奥关拉唑组(P＜0.01);两组在烧心和胸痛缓解率上差异明显(78.3% vs45.5%,64.3% vs 37.5%,均P＜0.05),在反酸、咽下困难上无明显差异:4wk和8 wk对RE内镜有效率和愈合率差异明显(4 wk:88.8% vs59.3%,80.0%vs51.9%:8 wk:96.0% vs 70.4%,88.O% 63.1%,均p＜0.05),埃索美拉唑组患者活力和社会功能疗效明显(92.5±5.7 vs 85.3±7.1,85.2±4.6 vs 76.8±6.5,均P＜0.05).结论:标准剂量的埃索美拉唑较加倍剂量的奥美拉唑更有效的控制GERD患者(尤其是RE患者)的临床症状,改善活力和社会功能相关的生活质量.     

老年胃食管反流病患者食管测压和24小时PH监测分析

我们于 1999年 7月至 2 0 0 0年 12月对老年胃食管反流病 (ＧＥＲＤ)患者进行食管ｐＨ监测和压力测定 ,并与青年、老年健康人进行了比较。　　一、对象与方法　　 1.对象 :(1)对照组 :老年对照组 2 0例 ,男性 15例 ,女性5例 ,年龄 6 1～ 83岁 ,平均 75岁。青年对照组 18例 ,均为男性 ,年龄 19～ 2 6岁 ,平均 2 1岁。老年对照组来自住院健康查体者 ,青年对照组来自本院医务工作者和战士。所有受检者均无胃食管反流症状 ,无累及食管的全身性疾病 (如糖尿病 ) ,无手术史和消化性溃疡病史。老年对照组均行胃镜检查 ,无食管疾病。 (2 )老年ＧＥＲ…     

Psychological Intervention Influences the Outcome of Laparoscopic Antireflux Surgery in Patients with Stress-related Symptoms of Gastroesophageal Reflux Disease

Background: Psychological aspects such as stress, emotions, illness behaviour or personality are known to affect the severity of symptoms of gastroesophageal reflux disease (GERD) and can influence medical outcome in some patients. The aim of the present study was to evaluate the efficacy of psychological intervention within routine surgical care on the surgical outcome of laparoscopic antireflux surgery (LARS) in patients with stress-ralated GERD symptoms during a 1-year follow-up. Methods: Out of a sample of 196 consecutive patients who required LARS (Nissen fundoplication), a group of 89 (45%) believed that stress was a factor in the cause of their symptoms (stress-related versus stress-unrelated GERD patients). Patients with stress-related symptoms were randomly assigned to the psychological intervention (PI group; n = 42) or control group with routine surgical care (RC group; n = 42). Five patients were excluded from the study. Assessments of surgical outcome were: objective clinical data such as DeMeester score or lower oesophageal sphincter pressure, Gastrointestinal Quality-of-Life Index (GIQLI), evaluation of potential side effects such as subjective degree of dysphagia, general impairment as a result of LARS, and patient satisfaction with surgery. Results: There were no significant differences in objective clinical data between the different treatment groups before and after surgery. Before surgery, patients with stress-related symptoms had a lower GIQLI and an increased spectrum of gastrointestinal (GI) symptoms compared with patients without stress-related symptoms. A significant impact (P &lt; 0.05-0.01) of psychological intervention on quality-of-life data, especially in GI symptoms, degree of dysphagia and general impairment, could be calculated after surgery. No differences in satisfaction with therapy were detectable. Comparing outcome, no significant differences between patients without stress-related GERD symptoms and the PI group were found. Generally, quality-of-life data in all patients improved significantly and patient satisfaction was excellent or good in 98.9% one year after surgery. In two patients a laparoscopic refundoplication was neccessary because of a 'slipping Nissen'. Conclusions: These findings indicate that there is no impact of psychological intervention on objective clinical data. Patients with stress-related GERD symptoms profit significantly from psychological intervention in patient-related factors of surgical outcome such as quality of life or degree of several aspects such as dysphagia and general impairment. Generally, LARS in patients with stress-related GERD symptoms is an effective and safe procedure which improves quality of life with fewer side effects. Psychological intervention reduces non GERD-related GI symptoms and makes the outcome comparable to the outcome of patients without stress-related symptoms. We therefore suggest that surgical treatment alone in patients with stress-related GERD symptoms is incomplete and that psychological intervention can optimize surgical outcome in these patients.     

Quality of Life and Surgical Outcome after Laparoscopic Antireflux Surgery in the Elderly Gastroesophageal Reflux Disease Patient

Background: Generally, treatment of gastroesophageal reflux disease (GERD) in the elderly follows the same principles as for any adult patient. Currently laparoscopic antireflux surgery (LARS) has not been clearly established in the elderly patient. The aim of this prospective study was to evaluate the surgical outcome including quality of life after LARS in patients older than 65 years. Methods: Since 1993 more than 500 patients underwent LARS in our institute. A total of 72 patients, older than 65 years, has been treated with laparoscopic 'floppy' Nissen (n = 51) or Toupet (n = 21) fundoplication. The patients included 23 women and 49 men, with a mean age of 71 years (range, 66-79 years). Quality of life was evaluated using the Gastrointestinal Quality of Life Index (GIQLI). The GIQLI was evaluated prior to surgery, and 3 months and 1 year after surgery, with 24-h pH monitoring and esophageal manometry being performed. Results:     

心理社会因素在非糜烂性反流病发病中作用的研究

背景：心理社会因素在功能性胃肠病中起重要作用，但在非糜烂性反流病（NERD）中的作用尚不明确。目的：探讨心理社会因素在NERD发病中的作用。方法：对在消化专科门诊就诊的有烧心、胸骨后疼痛、反酸和反食等症状的病例，行胃镜和24h食管pH监测等检查。对NERD进行分组，并对病理性酸反流组（n=49）、生理性酸反流组（n=50）和对照组（n=99）进行心理学评估。评估采用症状自评量表（SCL-90）、Beck抑郁自评量表、状态-特质焦虑问卷（STAI）等量表。结果：SCL-90评估显示NERD患者的躯体化、强迫、人际关系、抑郁、焦虑、敌对、偏执等因子分和总症状分均显著高于对照组（P〈0．05）；NERD患者病理性酸反流组的躯体化、人际关系、焦虑、偏执等因子分和总症状分均显著高于生理性酸反流组（P〈0．05），而强迫、抑郁、敌对、恐怖、精神病性等因子分，则两组间差异无显著性（P〉0．05）；NERD患者的状态焦虑量表（SAI）评分显著高于对照组（P〈0．01），而Beck抑郁自评量表、特质焦虑量表评分与对照组的差异无显著性（P〉0．05）；病理性酸反流组的状态焦虑量表（SAI）评分高于生理性酸反流组（P〈0．01）。结论：心理社会因素在NERD的症状产生中可能有一定的作用；病理性酸反流组的心理异常较生理性酸反流组更为明显。     

反流性食管炎和非糜烂性反流病患者的疾病认知和既往诊治情况调查

背景:胃食管反流病(GERD)是临床常见疾病,患者常反复就医,医疗资源耗费大。目的:了解GERD患者对疾病的认知和既往诊治情况,探讨其影响因素。方法:对GERD患者行问卷调查,分析反流性食管炎(RE)和非糜烂性反流病(NERD)患者的人口学特征、就诊原因、疾病认知和既往诊治情况。结果:共244例GERD患者接受调查,NERD152例,RE92例。就诊原因为反流相关症状、明确诊断和担心患肿瘤者分别占75.4%、31.5%和26.1%。34.8%的患者对罹患该病非常担心紧张,23.0%的患者诊疗费用≥20 000元,仅23.4%的患者对既往治疗效果表示满意。Logistic回归分析显示,性别、年龄是疾病认知的主要影响因素,病程长、RE是诊疗费用高的主要危险因素,年龄是满意度的主要影响因素。RE和NERD组对该病不甚了解者均达85%以上。RE组男性、轻体力劳动者比例和腹围、体重指数显著高于NERD组,因担心患肿瘤而就诊、曾接受非药物治疗、诊疗费用≥20 000元者比例亦高于NERD组,且较NERD组更担心发展为食管癌和药物不良反应。结论:GERD患者对该病的认知有限,诊疗费用高。有针对性地对不同类型的GERD患者进行疾病认知教育,加强非药物治疗的宣教,有望节约医疗资源,更好地治疗疾病。     

胃食管反流病诊断方法的临床价值

胃食管反流病（GERD）虽可根据反流症状群、上消化道内镜检查、24h食管pH监测、质子泵抑制剂（PPI）诊断性治疗等综合分析而作出诊断,但目前尚缺乏统一、明确的诊断流程和标准,因此GERD的诊断仍存在诸多争议。本文就GERD相关诊断方法的临床价值作一综述。     

Depression as a Clinical Determinant of Dependence and Low Quality of Life in Elderly Patients with Cardiovascular Disease

Background

The aging process promotes a progressive increase in chronic-degenerative diseases. The effect of these diseases on the functional capacity has been well recognized. Another health parameter concerns “quality of life related to health”. Among the elderly population, cardiovascular diseases stand out due to the epidemiological and clinical impact. Usually, these diseases have been associated with others. This set of problems may compromise both independence and quality of life in elderly patients who seek cardiologic treatment. These health parameters have not been well contemplated by cardiologists.

Objective

Evaluating, among the elderly population with cardiovascular disease, which are the most relevant clinical determinants regarding dependence and quality of life.

Methods

This group was randomly and consecutively selected and four questionnaires were applied: HAQ, SF-36, PRIME-MD e Mini Mental State.

Results

The study included 1,020 elderly patients, 63.3% women. The group had been between 60 and 97 years-old (mean: 75.56 ± 6.62 years-old). 61.4% were independent or mild dependence. The quality of life total score was high (HAQ: 88.66 ± 2.68). 87.8% of patients had a SF-36 total score > 66. In the multivariate analysis, the association between diagnoses and high degrees of dependence was significant only for previous stroke (p = 0.014), obesity (p < 0.001), lack of physical activity (p = 0.016), osteoarthritis (p < 0.001), cognitive impairment (p < 0.001), and major depression (p < 0.001). Analyzing the quality of life, major depression and physical illness for depression was significantly associated with all domains of the SF-36.

Conclusion

Among an elderly outpatient cardiology population, dependence and quality of life clinical determinants are not cardiovascular comorbidities, especially the depression.     

胃食管阀瓣在胃食管反流病中的分布及其与症状的相关性

背景：近年我国胃食管反流病（GERD）的发生率不断升高,胃食管阎瓣（GEFV）分级对评估GERD有重要作用。目的：探讨GEFV在GERD中的分布特征及其与患者症状的关系。方法：选取2010年1～12月聊城市人民医院行胃镜检查发现的343例糜烂性食管炎（EE）、483例非糜烂性反流病（NERD）和99例Barrett食管（BE）患者,记录GEFV的Hill分级,采用GERD症状评定量表（GSAS）记录症状频率、严重度评分。比较GERD各型中GEFV的分布及其与症状频率、严重度评分的关系。结果：异常GEV多见于男性、高龄、超重和食管裂孔疝患者。随着EE的Los Angeles分级增加,异常GEV的发生率增加（P=0.002）;GEFV分级在EE、NERD和BE组间的分布无明显差异（P=0.612）：与正常GEFV组相比,异常GEFV组GERD的症状频率评分明显增高（P〈0.05）,而症状严重度评分无明显差异（P〉0.05）。多重线性回归分析显示症状频率评分与年龄、GEFV分级和GERD类型相关（P〈0.05）,症状严重度评分与年龄、GERD类型相关（P〈0.05）。结论：GEFV分级在GERD各亚型中的分布无明显差异,而与GERD症状频率相关。