抬高床頭於胃食道逆流疾病之系統性文獻回顧－－食道癌術後之應用

A Systematic Review of the Literature Related to Elevating the Head of the Bed for Patients With Gastroesophageal Reflux Disease: Applications in Patients After Esophageal Cancer Surgery

背景：胃食道逆流影響病患生活品質，夜間睡覺時更因為食道蠕動降低而加重酸液逆流情形，除直接影響睡眠品質，亦增加逆流性食道炎的發生，引發癌細胞病變。由於食道癌患者接受食道切除及重建手術後發生酸液逆流的機會高達80%，如何改善此症狀以提升食道癌術後病患之生活品質極為重要。目的：探討夜間睡眠時抬高床頭對於改善胃食道逆流患者的成效，作為應用於食道癌術後病患改善胃酸逆流症狀相關研究與臨床應用之參考。方法　本文以系統性文獻回顧法，搜尋2015年6月以前，發表於國內外相關利用夜間睡眠時抬高床頭的介入措施改善胃食道逆流患者的文章，資料庫包括Cochrane Library、CINAHL（Cumulative Index to Nursing and Allied Health Literature）、PubMed、MEDLINE等資料庫，使用關鍵字抬高床頭、平躺、 逆流，共獲得37篇相關文獻，最後選擇符合主題且證據等級較高的3篇隨機控制實驗及1篇類實驗研究。結果　文獻回顧結果發現，經由食道內酸鹼值檢測，抬高床頭能降低食道曝露在酸性環境的時間，同時獲得自覺症狀的改善，且比單獨使用藥物對胃酸逆流的控制效果更佳。結論／實務應用　抬高床頭可降低逆流症狀，抬高的高度建議為20-28cm，且必須考量抬高時身體彎曲的幅度，未來可應用於改善食道癌術後的胃酸逆流狀況，但仍需要更多隨機控制的研究設計以驗證此成效。

Background: Acid regurgitation typically worsens during nighttime sleep, which influences the quality of life of patients and potentially causes pathological changes. As much as 80% of esophageal cancer patients experience acid regurgitation following esophagectomy and reconstruction surgery. Thus, improving this symptom is important to improving the quality of life of these patients. Purpose: The purpose of the present study was to evaluate the effect of elevating the head of the bed for patients with gastroesophageal reflux disease (GERD). Method: A systematic review was used. Electronic databases including CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, ProQuest, and PubMed/MEDLINE were retrieved for relevant articles that were published prior to June 2015. Keywords included ＂elevating the head of the bed/bed position/body position＂, ＂flat＂, ＂reflux＂, and the MeSh term ＂gastroesophageal reflux＂. A total of 37 articles that matched the search criteria were extracted. After screening the topics and deleting repetitions, three randomized controlled studies and one quasi- experimental designed study were selected. Results: Results of this systemic review revealed that elevating the head of the bed for patients with GERD reduced the duration of exposure of the the esophagus to an acid environment. Furthermore, patients perceived that this intervention not only improved symptoms such as regurgitation and burn sensation without medication but also relieved symptoms better than taking medications alone. Conclusions: The reviewed studies support that elevating the head of the bed is an easy and effective way to alleviate the symptoms of acid regurgitation. A height of elevation of 20 to 28 cm is recommended in the literature. The slope of the elevated bed must also be considered. Elevating the head of the bed may be useful for improving acid regurgitation among esophageal cancer patients after surgery. A randomized controlled study may be used to validate this effect in the future.