哮喘和慢阻肺急性加重期食管24小时pH监测

24 Hour Esophageal pH Monitoring in Patients with Acute Attack Asthma and COPD

应用食管24小时动态监测仪对哮喘发作期和慢性阻塞性肺疾病（慢阻肺）急性加重期进行研究。其中哮喘发作期（A组）23例，慢阻肺急性加重期（B组）20例，正常对照组（C组）10例。对其中12例并发GER的病人应用雷尼替丁和奥美拉唑治疗前后进行24小时pH监测。结果：24小时食管pH＜4的总时间百分丰，pH＜4的立位总时间百分率，pH＜4的卧位急时间百分率，反流≥5分钟的次数，最长反流持续时间pH＜4的反流次数以及总计分，A、B两组均显著高于对照组（P＜0．01），而且A组显著高于B组。以总计分＞16．7为判断标准，A组GER发生率87％，B组70％。pH＜4的发作时间与哮喘发作呈正相关（γ-0．602，P＜0．005），总计分与哮喘病情严重度呈正相关关系（γ=0．537，P＜0．01）。伴有GER的病人经雷尼替丁（8例）和奥美拉唑（4例）治疗2周后，24小时食管pH各项指标基本正常（P＜0．01）。结论：哮喘和慢阻肺急性加重期GER发生率显著升高，宜常规进行食管24小时pH监测，如发现GER，及时应用H2受体拮抗剂或质子泵抑制剂治疗，两者均是治疗GER的有效药物。

Objective:To determine the relationship between gastroesophgeal reflux(GER) and pulmonary disease,patients with acute attack asthma and COPD were studied with 24 hour esophgeal pH monitor. Methods:23 asthmatics, 20 patients wothCOPD nd 10 control subjectS were divided into groups A, B and C. CER was diagnosed by 24 hour pH monitoring.Of which,12 patients with GER were stueied before and after being treated with Ranitidine and Omeprazole .Results:6 observable components of esophageal acid exposure:total fraction time pH < 4, uorigh fortion time pH < 4, supine fraction tim pH< 4, number of de ePisodes≥5 .0 minutes, longest reflux episode , number of reflux epieodes and composite score, were significantly different from the results of groups A, B and C (P < 0.01),and significant difference was also noted between the results from groups A bo B(P < 0.05) .Frequency of GER in A was 87%; in B was 70%. There were positive correlation between the time of pH <4 and attack time of asthma(γ = 0.all, P < 0.05) and between the compositive score and severity of asthma attack (γ =0.537, P < 0.01 ). The 6 observable components of esophageal acid exposure in 12 patients with GER had recovered after treating with ranitidine and Omeprazole. Conclusion: Most patients with acute attack asthma and COPD have abnomal GER. For these patients, 24- h esopheal pH monitoring ought to be montored routinly,and the patients with GER ought to be treatedwith H2 - receptor antagonists or omeprazole,both of which are effective mediine.