氫離子幫浦抑制劑輔以衛生教育介入對胃食道逆流性疾病及其症狀影響尺度改善之探討

The Effect of Proton Pump Inhibitors (PPIs) along with Health Education Intervention on Gastroesophageal Reflux Disease (GERD) and the Disease Impact Scale

黃勇傑(Yung-Chieh Huang) ； 朱恆成(Heng-Cheng Chu) ； 高森永(Sen-Yeong Kao)

《台灣公共衛生雜誌》 31卷2期 (2012/04) Pp. 152-163

https://doi.org/10.6288/TJPH2012-31-02-07

摘要

目標：現行臨床針對胃食道逆流疾病（Gastroesophageal Reflux Disease, GERD）病人之治療僅著重內科藥物之投予或採外科手術治療，鮮少提供衛教介入之輔助性治療或評估衛教介入之成效。因此，本研究旨在探討臨床上投予氫離子幫浦抑制劑（Proton Pump Inhibitor, PPIs）輔以衛生教育介入，以6－8週之追蹤期間了解其對GERD病人之危險因子、疾病認知、態度與行為、改良型GERD症狀影響尺度（mGIS）及內視鏡嚴重度改善之成效，進而探討mGIS改變量（ΔmGIS）之預測因子。方法：本研究為隨機控制試驗（Randomized Controlled Trial, RCT）並追蹤6－8週，將181位GERD病人隨機分派至實驗組（N＝92）或控制組（N＝89）。實驗組接受PPIs治療及衛生教育介入措施；控制組則接受PPIs治療及門診常規照護。結果：實驗組與控制組於飲食、生活習慣或行為、GERD認知、態度與行為及mGIS之改善情形達顯著差異。經多元逐步迴歸分析後顯示：實驗組提升GERD認知（β＝1.221，t＝2.716）、避免吃甜食（β＝0.101，t＝3.644）及睡覺枕頭刻意墊高（β＝0.539，t＝=12.344）為ΔmGIS之預測因子。結論：本研究證實PPIs輔以衛教介入可有效改善GERD病人部分不良飲食習慣及生活習慣或行為，並增進對疾病相關認知、態度與行為及減少受疾病影響之程度。其中實驗組於衛教介入後改善不良危險因子者，其受疾病影響程度呈顯著減少。

關鍵字

胃食道逆流性疾病 ； 氫離子幫浦抑制劑 ； 衛生教育介入 ； 改良型胃食道逆流性疾病影響尺度（mGIS）

並列摘要

Objectives: Gastroesophageal Reflux Disease (GERD) has become a public health issue in Taiwan; however, current clinical treatment focuses only on surgery or drugs to inhibit gastric acid secretion, and seldom takes into consideration the effect of concurrent health education which includes diet, lifestyle modification, and disease knowledge, attitude and practice (KAP). The aims of this study were to evaluate the concurrent effects of health education and Proton Pump Inhibitors (PPIs) on diet, lifestyle changes, KAP, the modified GERD impact scale (mGIS), and severity of the condition as determined by endoscopy, and to further explore the predictors of difference on the modified GERD impact scale (ΔmGIS). Methods: A 6-8 week randomized controlled trial was conducted at a medical center between 2010 and 2011. This involved 181 gastroenterology outpatients with GERD. Participants were randomly assigned to one of two treatment strategies: 89 in the medication management (PPIs) only group and 92 in the medication management (PPIs) plus concurrent health education group. Results: The experimental group was significantly better than the control group in avoiding or decreasing related risk factors, increasing disease KAP, and decreasing mGIS. Multiple linear regression (stepwise) analysis showed that improved knowledge (β=1.221, t=2.716), sleeping with the head of the bed raised (β=0.539, t=12.344) and avoiding or decreasing eating sweets (β=0.101, t=3.644) were ΔmGIS predictors. Conclusions: PPIs and concurrent health education may be the best way to improve patients' diet, lifestyle, and disease related KAP, and reduce the severity of clinical symptoms.

並列關鍵字

Gastroesophageal Reflux Disease ； Proton Pump Inhibitors (PPIs) ； health education intervention ； modified Gastroesophageal Impact Scale (mGIS)

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