中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
4期
298-302
,共5页
张娟%李在玲%葛颖%王琨%徐志杰%夏至伟%段丽萍
張娟%李在玲%葛穎%王琨%徐誌傑%夏至偉%段麗萍
장연%리재령%갈영%왕곤%서지걸%하지위%단려평
胃食管反流%婴儿,早产%多通道腔内阻抗
胃食管反流%嬰兒,早產%多通道腔內阻抗
위식관반류%영인,조산%다통도강내조항
Gastroesophageal reflux%Infant,premature%Multichannel intraluminal impedance
目的 评价24 h食管多通道腔内阻抗(MⅡ)联合pH监测技术在早产儿中的临床应用情况.方法 28例临床考虑有胃食管反流(GER)症状(呕吐、呼吸暂停、氧饱和度下降)的早产儿.其中男20例,女8例,胎龄26 ～ 32周,平均(28.9±1.9)周,出生体重850 ～1 700 g,平均(1 250.4±272.8)g,检查时矫正胎龄28 ～40周,平均(34.5±2.3)周.行24 h食管MⅡ及pH监测,数据被保存在便携式记录器的储存卡内用专业软件分析.将传统pH值监测指标阳性患儿归为GER阳性组,阴性为GER阴性组.采用SPSS 17.0软件,计量资料呈正态分布的以均数±标准差表示,采用t检验;非正态分布的用中位数(范围)表示,采用Mann-Whitney U非参数检验.结果 28例早产儿中,pH值监测法GER检出率为71.4％(20/28),MⅡ联合pH值法检出率为100％,优于pH值检测法.胎龄、出生体重、矫正胎龄与GER无关.氧饱和度下降、呼吸暂停、呕吐症状在GER阳性组及GER阴性组间差异无统计学意义.8例GER阴性组无病理性酸反流,但阻抗监测提示弱酸反流较GER阳性组增加(P＜0.01).28例患儿24h总反流事件中位数为64.5(0～377)次,其中酸反流占总反流事件的23.4％,弱酸反流占所有反流事件的76.4％.液体反流占总反流的59.1％,混合反流占总反流40.9％.MⅡ联合pH监测使症状相关指数和症状联合概率阳性比率较应用pH监测时明显升高.结论 24 h MⅡ联合pH监测技术应用于早产儿安全性高,具有较好的耐受性.可发现弱酸反流及液体、混合反流,为更好地解释GER与临床表现的关系提供了可能.
目的 評價24 h食管多通道腔內阻抗(MⅡ)聯閤pH鑑測技術在早產兒中的臨床應用情況.方法 28例臨床攷慮有胃食管反流(GER)癥狀(嘔吐、呼吸暫停、氧飽和度下降)的早產兒.其中男20例,女8例,胎齡26 ～ 32週,平均(28.9±1.9)週,齣生體重850 ～1 700 g,平均(1 250.4±272.8)g,檢查時矯正胎齡28 ～40週,平均(34.5±2.3)週.行24 h食管MⅡ及pH鑑測,數據被保存在便攜式記錄器的儲存卡內用專業軟件分析.將傳統pH值鑑測指標暘性患兒歸為GER暘性組,陰性為GER陰性組.採用SPSS 17.0軟件,計量資料呈正態分佈的以均數±標準差錶示,採用t檢驗;非正態分佈的用中位數(範圍)錶示,採用Mann-Whitney U非參數檢驗.結果 28例早產兒中,pH值鑑測法GER檢齣率為71.4％(20/28),MⅡ聯閤pH值法檢齣率為100％,優于pH值檢測法.胎齡、齣生體重、矯正胎齡與GER無關.氧飽和度下降、呼吸暫停、嘔吐癥狀在GER暘性組及GER陰性組間差異無統計學意義.8例GER陰性組無病理性痠反流,但阻抗鑑測提示弱痠反流較GER暘性組增加(P＜0.01).28例患兒24h總反流事件中位數為64.5(0～377)次,其中痠反流佔總反流事件的23.4％,弱痠反流佔所有反流事件的76.4％.液體反流佔總反流的59.1％,混閤反流佔總反流40.9％.MⅡ聯閤pH鑑測使癥狀相關指數和癥狀聯閤概率暘性比率較應用pH鑑測時明顯升高.結論 24 h MⅡ聯閤pH鑑測技術應用于早產兒安全性高,具有較好的耐受性.可髮現弱痠反流及液體、混閤反流,為更好地解釋GER與臨床錶現的關繫提供瞭可能.
목적 평개24 h식관다통도강내조항(MⅡ)연합pH감측기술재조산인중적림상응용정황.방법 28례림상고필유위식관반류(GER)증상(구토、호흡잠정、양포화도하강)적조산인.기중남20례,녀8례,태령26 ～ 32주,평균(28.9±1.9)주,출생체중850 ～1 700 g,평균(1 250.4±272.8)g,검사시교정태령28 ～40주,평균(34.5±2.3)주.행24 h식관MⅡ급pH감측,수거피보존재편휴식기록기적저존잡내용전업연건분석.장전통pH치감측지표양성환인귀위GER양성조,음성위GER음성조.채용SPSS 17.0연건,계량자료정정태분포적이균수±표준차표시,채용t검험;비정태분포적용중위수(범위)표시,채용Mann-Whitney U비삼수검험.결과 28례조산인중,pH치감측법GER검출솔위71.4％(20/28),MⅡ연합pH치법검출솔위100％,우우pH치검측법.태령、출생체중、교정태령여GER무관.양포화도하강、호흡잠정、구토증상재GER양성조급GER음성조간차이무통계학의의.8례GER음성조무병이성산반류,단조항감측제시약산반류교GER양성조증가(P＜0.01).28례환인24h총반류사건중위수위64.5(0～377)차,기중산반류점총반류사건적23.4％,약산반류점소유반류사건적76.4％.액체반류점총반류적59.1％,혼합반류점총반류40.9％.MⅡ연합pH감측사증상상관지수화증상연합개솔양성비솔교응용pH감측시명현승고.결론 24 h MⅡ연합pH감측기술응용우조산인안전성고,구유교호적내수성.가발현약산반류급액체、혼합반류,위경호지해석GER여림상표현적관계제공료가능.
Objective To evaluate the clinical application of 24-hour esophageal muhichannel intraluminal impedance-pH monitoring technique in preterm infants.Method This study enrolled 28 preterm(male 20,female 8)infants with symptoms suggestive of gastroesophageal reflux (GER) (frequent regurgitations,apnea,or transcutaneous oxygen saturation decreased).They had postmenstrual age from 26 to 32 weeks,median (28.9 ± 1.9) weeks,had birth weight from 850 to 1 700 g,median (1 250.4 ±272.8)g,range 850-1700 g,and were studied at corrected gestational age from 28 to 40 weeks,median (34.5 ± 2.3) weeks.Combined measurement of esophageal pH and impedance was performed.The 24-hour pH-impedance recording was uploaded onto a portable storage card and for computer-assisted manual analysis,using a specialized software program.When values were distributed normally,they were presented as mean and standard deviation,compared using t test.When values were not distributed normally,they were presented as median,minimum and maximum.Median values were compared using the Mann-Whitney U non-parametric test.SPSS 17.0 software was used.Result In 28 preterm infants,71.4％ (20/28) had pathological acid refluxes with pH monitor,while 100％ with combined measurement of esophageal pH and impedance.Gestational age,birth weight,corrected gestational age had no association with acid GER.Frequent regurgitations,apnea,or transcutaneous oxygen saturation decreased but there was no statistically significant difference between acid GER group and non-acid GER group.Eight cases had no pathological acid refluxes,but showed an increase of weakly acid refluxes than pathological acid refluxes group (P ＜0.01).The median number of reflux events in 24 hours for 28 cases was 64.5 (0-377),23.4％ were acidic,while 76.4％ were weakly acidic; 59.1％ were liquid bolus refluxes,while 40.9％ were mixed bolus refluxes.The positive ratio of symptoms related index and symptoms association probability were significantly increased combined measurement of esophageal pH and impedance versus pH monitor were used.Conclusion The 24-hour esophageal impedance-pH monitoring technique was safe and had good tolerance.We confirmed that it detected more weakly acidic refluxes,liquid bolus refluxes,and mixed bolus refluxes.And it provided more evidence for explaining the relationship between GER and clinical manifestation.
