中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2011年
11期
931-934
,共4页
高岩%尚占民%黄皖农%郝建宇
高巖%尚佔民%黃皖農%郝建宇
고암%상점민%황환농%학건우
胃食管反流%咳嗽,慢性%食管功能%反流特点
胃食管反流%咳嗽,慢性%食管功能%反流特點
위식관반류%해수,만성%식관공능%반류특점
Gastroesophageal reflux%Cough,chronic%Esophageal function%Characteristicsof reflux
目的 通过对以慢性咳嗽为主要表现的胃食管反流病(GERD)患者行高分辨食管内压力-阻抗联合测定(MII-HRM)及24h联合多通道腔内阻抗-pH( MII-pH)监测的结果分析,探讨此类患者食管运动功能及胃食管反流的特点.方法 选取2010年3-11月在首都医科大学附属北京朝阳医院就诊的19例GERD伴慢性咳嗽患者为研究对象.应用MII-HRM及24 h MII-pH监测系统测定上食管括约肌(UES)和下食管括约肌压力、食管体部蠕动功能、对液体和黏液性物质的传输功能、立位及卧位酸及非酸反流的次数、近端反流的次数、酸暴露时间、酸清除时间以及食团清除时间.以同期仅表现为典型胃食管反流症状的17例GERD患者作为对照,比较两组间食管运动功能以及胃食管反流参数的差异.结果 与仅表现为典型胃食管反流症状的GERD患者相比,以慢性咳嗽为主要表现的GERD患者的UES静息压力明显更低[(122.55 ±60.48)mm Hg比(86.37±41.35) mm Hg(1 mm Hg =0.133 kPa),P＜0.05],食管体部异常蠕动的比例更高[(9.47±15.63)％比(22.16±17.45)％,P＜0.05],食管体部对液体物质传输能力减低[(88.82±12.23)％比(71.68±23.06)％,P＜0.05],卧位时酸及非酸反流次数及卧位近端非酸反流次数明显增多(P＜0.05),卧位食团清除时间延长(P＜0.05).结论 以慢性咳嗽为主要表现的GERD发病机制可能与单纯典型GERD不同,其与UES静息压力减低、卧位酸及非酸反流、近端反流的增多以及食管清除功能障碍密切相关.
目的 通過對以慢性咳嗽為主要錶現的胃食管反流病(GERD)患者行高分辨食管內壓力-阻抗聯閤測定(MII-HRM)及24h聯閤多通道腔內阻抗-pH( MII-pH)鑑測的結果分析,探討此類患者食管運動功能及胃食管反流的特點.方法 選取2010年3-11月在首都醫科大學附屬北京朝暘醫院就診的19例GERD伴慢性咳嗽患者為研究對象.應用MII-HRM及24 h MII-pH鑑測繫統測定上食管括約肌(UES)和下食管括約肌壓力、食管體部蠕動功能、對液體和黏液性物質的傳輸功能、立位及臥位痠及非痠反流的次數、近耑反流的次數、痠暴露時間、痠清除時間以及食糰清除時間.以同期僅錶現為典型胃食管反流癥狀的17例GERD患者作為對照,比較兩組間食管運動功能以及胃食管反流參數的差異.結果 與僅錶現為典型胃食管反流癥狀的GERD患者相比,以慢性咳嗽為主要錶現的GERD患者的UES靜息壓力明顯更低[(122.55 ±60.48)mm Hg比(86.37±41.35) mm Hg(1 mm Hg =0.133 kPa),P＜0.05],食管體部異常蠕動的比例更高[(9.47±15.63)％比(22.16±17.45)％,P＜0.05],食管體部對液體物質傳輸能力減低[(88.82±12.23)％比(71.68±23.06)％,P＜0.05],臥位時痠及非痠反流次數及臥位近耑非痠反流次數明顯增多(P＜0.05),臥位食糰清除時間延長(P＜0.05).結論 以慢性咳嗽為主要錶現的GERD髮病機製可能與單純典型GERD不同,其與UES靜息壓力減低、臥位痠及非痠反流、近耑反流的增多以及食管清除功能障礙密切相關.
목적 통과대이만성해수위주요표현적위식관반류병(GERD)환자행고분변식관내압력-조항연합측정(MII-HRM)급24h연합다통도강내조항-pH( MII-pH)감측적결과분석,탐토차류환자식관운동공능급위식관반류적특점.방법 선취2010년3-11월재수도의과대학부속북경조양의원취진적19례GERD반만성해수환자위연구대상.응용MII-HRM급24 h MII-pH감측계통측정상식관괄약기(UES)화하식관괄약기압력、식관체부연동공능、대액체화점액성물질적전수공능、립위급와위산급비산반류적차수、근단반류적차수、산폭로시간、산청제시간이급식단청제시간.이동기부표현위전형위식관반류증상적17례GERD환자작위대조,비교량조간식관운동공능이급위식관반류삼수적차이.결과 여부표현위전형위식관반류증상적GERD환자상비,이만성해수위주요표현적GERD환자적UES정식압력명현경저[(122.55 ±60.48)mm Hg비(86.37±41.35) mm Hg(1 mm Hg =0.133 kPa),P＜0.05],식관체부이상연동적비례경고[(9.47±15.63)％비(22.16±17.45)％,P＜0.05],식관체부대액체물질전수능력감저[(88.82±12.23)％비(71.68±23.06)％,P＜0.05],와위시산급비산반류차수급와위근단비산반류차수명현증다(P＜0.05),와위식단청제시간연장(P＜0.05).결론 이만성해수위주요표현적GERD발병궤제가능여단순전형GERD불동,기여UES정식압력감저、와위산급비산반류、근단반류적증다이급식관청제공능장애밀절상관.
Objective To investigate the characteristics of gastroesophageal reflux disease (GERD) with chronic cough by the results of combined multichannel intraluminal impedance and high-resolution manometry (MII-HRM) procedure and 24-hour muhichannel intraluminal impedance combined pH (MII pH) monitoring.Methods From March 2010 to November 2010,consecutive patients of GERD with chronic cough (more than 8 weeks) admitted to Beijing Chaoyang Hospital of Capital Medical University underwent 24-hour MII-pH monitoring and MII-HRM procedure with symptom association probability(SAP) over 95％.Data of lower esophageal sphincter (LES) pressure,LES relaxation,LES residual pressure,esophageal body peristalsis function and swallow bolus transit (liquid/viscous) was collected and the result of 24-hour MII-pH monitoring was analysed by the computer software containing reflux episode activity (acid/nonacid,upright/recumbent),proximal extent,acid exposure and mean acid/bolus clearance time.Seventeen patients of GERD with typical reflux symptom were selected as the control group.Results Comparing with patients of GERD with typical reflux symptom,patients of GERD with chronic cough showed decreased upper esophageal sphincter pressure (UESP) [( 122.55 ± 60.48 )mm Hg vs ( 86.37 ± 41.35 ) mm Hg,P ＜ 0.05,1 mm Hg =0.133 kPa ],higher percentage of abnormality peristalsis [(9.47 ± 15.63 ) ％ vs ( 22.16 ± 17.45 ) ％,P ＜ 0.05 ],degraded esophagus transmittability of liquid substance [( 88.82 ± 12.23) ％ vs ( 71.68 ± 23.06 ) ％,P ＜ 0.05 ],more reflux episode activity ( acid/nonacid ) in supine position and proximal reflux episode (nonacid) in supine position (P ＜ 0.05 )and longer mean bolus clearance time( P ＜ 0.05 ).Conclusion Decrease of the UESP,increase of the reflux episode activity (acid/nonacid) in supine position and proximal reflux episode (nonacid) in supine position,lengthened mean bolus clearance time in supine position and the degraded esophagus clearance ability may all correlated with the pathogenesy of GERD with chronic cough.
