婴幼儿胃食管反流相关性咳嗽治疗的初步研究

Darryl J. Adamko; Carina M. Majaesic; Christopher Skappak; Adrian B. Jones

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中国当代儿科杂志 ›› 2012, Vol. 14 ›› Issue (5) : 321-327.

国外儿科研究

婴幼儿胃食管反流相关性咳嗽治疗的初步研究

Darryl J. Adamko, Carina M. Majaesic, Christopher Skappak, Adrian B. Jones

作者信息 +

A pilot trial on the treatment of gastroesophageal reflux-related cough in infants

Darryl J. Adamko, Carina M. Majaesic, Christopher Skappak, Adrian B. Jones

Author information +

文章历史 +

摘要

目的：婴幼儿哮喘的诊断主要基于咳嗽及喘息等临床症状，神经系统功能正常的婴幼儿当出现过度胃食管反流时也可以出现类似症状。目前并无随机对照研究来评价单独使用质子泵抑制剂或联合促动力药在婴幼儿中应用的疗效。目的本研究的主要目的是证实在呼吸道症状提示哮喘的婴幼儿中的确存在过度胃食管反流。其次，通过随机空白对照试验，探讨使用氨基甲酰甲基胆碱和奥美拉唑治疗过度胃食管反流可否改善呼吸道症状。方法：有慢性咳嗽或喘息病史且有病史支持、pH监测异常或胃排空扫描提示胃食管反流的婴幼儿22例，随机分为4个治疗组：安慰剂+安慰剂（PP治疗组）、奥美拉唑+氨基甲酰甲基胆碱（OB治疗组）、奥美拉唑+安慰剂（OP治疗组）、氨基甲酰甲基胆碱+安慰剂（BP治疗组）。通过临床问卷调查、检查和家庭日记以及pH监测数据评估患儿上述治疗前后及奥美拉唑+氨基甲酰甲基胆碱非盲试验后的情况。结果：19例纳入数据统计。PP治疗对胃食管反流或呼吸道症状没有作用，pH监测提示胃食管反流并无减少。然而根据pH监测及家长评估，OB治疗可减少胃食管反流，同时显著减少日间咳嗽，改善呼吸，无不良反应发生。结论：对于临床表现提示慢性胃食管反流相关性咳嗽的婴幼儿，使用奥美拉唑和氨基甲酰甲基胆碱治疗是可行的选择。

Abstract

OBJECTIVE: Diagnosing asthma in infancy is largely made on the basis of the symptoms of cough and wheezing. A similar presentation can be seen in neurologically normal infants with excessive gastroesophageal reflux (GER). There are no randomized placebo controlled studies in infants using proton pump inhibitors (PPI) alone or in addition to prokinetic agents. The primary objective was to confirm the presence of excessive GER in a population of infants that also had respiratory symptoms suggestive of asthma. Second, in a randomized placebo-controlled fashion, we determined whether treatment of GER with bethanacol and omeprazole could improve these respiratory symptoms. METHODS: Infants (n=22) with a history of chronic cough and wheeze were enrolled, if they had evidence of GER by history and an abnormal pH probe or gastric emptying scan. Infants were randomly allocated to four treatment groups: placebo/placebo (PP), omeprazole plus bethanacol (OB), omeprazole/placebo (OP), bethanacol/placebo (BP). Evaluations by clinic questionnaire and exam, home diary, and pH probe data were done before, after study-medication and after open label of OB. RESULTS: Nineteen children were studied. PP did not affect GER or respiratory symptoms, and did not decrease GER measured by pH probe. In contrast, OB decreased GER as measured by pH probe indices and parental assessment. In association, OB significantly decreased daytime coughing and improved respiratory scores. No adverse effects were reported. CONCLUSIONS: In infants with a clinical presentation suggestive of chronic GER-related cough, the use of omeprazole and bethanacol appears to be viable therapeutic option.

导出引用

Darryl J. Adamko, Carina M. Majaesic, Christopher Skappak, Adrian B. Jones. 婴幼儿胃食管反流相关性咳嗽治疗的初步研究[J]. 中国当代儿科杂志. 2012, 14(5): 321-327

Darryl J. Adamko, Carina M. Majaesic, Christopher Skappak, Adrian B. Jones. A pilot trial on the treatment of gastroesophageal reflux-related cough in infants[J]. Chinese Journal of Contemporary Pediatrics. 2012, 14(5): 321-327

中图分类号： R725.7

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