根除幽门螺杆菌失败后两种补救方案疗效分析.docVIP

根除幽门螺杆菌失败后两种补救方案疗效分析 　　摘要：目的观察10d序贯疗法与含铋剂四联疗法在三联疗法根除幽门螺杆菌失败后两种补救方案的疗效分析及用药安全性。方法入选86例经胃镜检查确诊为H.Pylori阳性的慢性胃炎和消化性溃疡患者，用三联疗法根除H.Pylori治疗，停药4Wk后14C尿素呼气试验仍为阳性的患者判定为根除失败。随机分为两组：序贯疗法组：（42例）方案为前5d，雷贝拉唑+阿莫西林，后5d给予雷贝拉唑+替硝唑+克拉霉素；含铋剂四联疗法组：（44例）给予雷贝拉唑+果胶必胶囊+阿莫西林+左氧氟沙星，连续7d，补救结束4Wk后复查14C尿素呼气试验，阴性者为HP补救根除成功，阳性为补救治疗失败。结果比较补救治疗后序贯疗法组患者的H.Pylori根除率82.05%，含铋剂四联疗法组为80.5%，不具有统计学意义（P＞0.05），两组均无严重不良反应。结论序贯疗法和含铋剂四联疗法可作为治疗三联疗法根除失败患者的安全、有效的补救治疗方案。 　　关键词：根除幽门螺杆菌；补救方案 　　The Study of Two kinds of Rescue Therapy after a Failed First-Line Helicobacter pyloripost(H.P) Eradication Therapy 　　DONG Wei 　　(Department of Gastroenterology,Qionglai City MedicalCenter Hospital,Qionglai 611530,Sichuan,China) 　　Abstract：ObjectiveTo observe the efficacy of sequential therapy and containing bismuth agent quadruple therapy in patients who failed first-line H.Pylori eradication in thriple therapy. MethodsEight-six peotic ulcer or chronic atrophic gastritis patients who failed first-line thriple therapy were randanly divided into two group: sequential therapy(42 cases): rabepeazole 10mg and amoxillin 1g,twice daily for the first 5d,followed by rabepeazole 10mg ,clarithromycin 500mg and tinidazole 500mg,twice daily for the last 5d;containing bismuth agent quadruple therapy(44 caseas):rabepeazole 10mg and amoxillin 1g and levofloxacin 200 mg twice daily,and pectic bismuth 100mg Third daily for 7d.within 4Wk after the therapy ,the 14C-urea breath was performed to detect H.Pylori infection status .ResultsH.Pylori eradication rate was 82.05% in sequential therapy , 80.5% in containing bismuth agent quadruple therapy.There was no important different betwen the groups without severe adverse reaction . ConclusionTwo therapy were effective and safe rescue therapu after a failed first-line thiple therapy. 　　Key words：Helicobacter pylori eradication;Remedy 　　幽门螺杆菌感染现状是全球超过50%的人感染H.Pylori，随着三联方案在消化性溃疡H.Pylori感染中的广泛应用，甲硝唑、克拉霉素和阿莫西林敏感性下降，H.Pylori耐药性逐渐增强，H.Pylori根除率呈下降趋势[1]，因此根除治疗失败的病例如何进行补救治疗，成为消化科医生目前遇到的问题。本研究通过序贯疗法