[胃食管反流病治疗的典型错误]。

M. Chikunova, I. Khlynov, D. V. Khromtsova
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摘要

目的分析门诊条件下医生对胃食管反流病(GERD)临床治疗指南的依从性。材料与方法对104名全科医生进行匿名问卷调查。问卷内容包括生活方式的改变、质子泵抑制剂(PPI)的使用、给药剂量和时间、联合治疗和内镜控制。结果对问卷的分析显示,15.6%的医生经常与胃食管反流患者讨论改变生活方式的必要性,75%的医生偶尔讨论,9.4%的医生从不讨论。56.7%的医生从双剂量质子泵抑制剂开始治疗,无论食管损伤的内镜阶段如何。在61.5%的病例中,PPI给药方式与说明书推荐的不一致。糜烂性食管炎的基本疗程为4周、2周和8周,分别占45.2%、9.6%和45.2%。在14.4%的病例中,胃反流的治疗从联合治疗开始。在85.6%的病例中,单用PPI治疗无效。51.9%的医生采用内镜控制糜烂性食管炎,48.1%的应答者仅在没有临床效果的情况下才推荐这种诊断方法。结论我们的分析揭示了胃食管反流患者治疗中的典型错误,证明了专家控制和培训医师支持的重要性,并将现代质量标准引入到该病理患者的实际管理中。
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[TYPICAL ERRORS IN THERAPY OF GASTROESOPHAGEAL REFLUX DISEASE].
Aim To analyze compliance of doctors with the clinical guidelines for the management of patients with gastroesophageal reflux disease (GERD) under outpatient clinic conditions. Material and methods An anonymous questionnaire study involving 104 general practitioners was undertaken. The questionnaires included items concerning lifestyle modifications, the use of proton pump inhibitors (PPI), dosage and time of their administration, combined therapy and endoscopic control. Results The analysis of the filled questionnaires demonstrated that 15,6% of the doctors always discuss the necessity changing lifestyle with GERD patients, 75% of the doctors discuss it but occasionally, and 9,4% never hold such discussions. 56,7% of the doctors begin treatment from double doses of proton pump inhibitors regardless of the endoscopic stage of esophagus damage. The mode of PPI administration is at variance with that recommended by the instruction in 61,5% of the cases. The basic course of erosive esophagitis treatment lasts 4, 2, and 8 weeks in 45,2%, 9,6%, and 45,2% of the cases. Treatment of GERD starts from combined therapy in 14,4% of the cases. Monotherapy with PPI is inefficient in 85,6% of the cases. Endoscopic control of erosive esophagitis is practiced by 51,9% of the doctors, 48,1% of the respondents recommend this diagnostic procedure only in the absence of clinical effect. Conclusion Our analysis revealed typical mistakes in the treatment of patients with GERD, demonstrated the importance of expert control and support of training physicians, and introduction of modern quality standards into the practical management of patients with this pathology.
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