pH电极位置对反流性食管炎酸监测的影响

Effects on the Localization of pH Probe in Esophageal Acid Monitoring for Patients with Reflux Esophagitis

为探讨ｐＨ电极位置对反流性食管炎酸监测的影响，将６０例反流性食管炎随机分为对照（Ｃ）组和试验（Ｔ）组。 Ｃ组 ３０例用测压法将 ｐＨ电极置于下食管括约肌（ＬＥＳ）上缘 ５ ｃｍ处；Ｔ组 ３０例用 ｐＨ梯度法将电极放于胃食管连接处（ＧＥＪ）上方 ５ ｃｍ处。连续 ２４ ｈ ｐＨ监测。结果显示，Ｃ与Ｔ组前鼻孔至ＧＥＪ平均距离分别为（４６． ２±４．１） ｃｍ与（４６． ５±４． ５） ｃｍ，两者无明显差异（Ｐ＝０． ８）。两组前鼻孔至ＧＥＪ平均距离（４６． ３±４． ３） ｃｍ比 Ｃ组前鼻孔至ＬＥＳ上缘平均距离（４３． ３±３． １） ｃｍ低 ３． ０ ｃｍ（Ｐ＝０． ０００３）。食管酸监测的 ｐＨ＜４，总百分时间和总计分在Ｔ组（８．５和 ４５． ５）和Ｔ组中ＧＥＪ＞ＬＥＳ上缘＋３ ｃｍ和＜－３ｃｍ范围者（１０． ０和 ９９． ３）较Ｃ组（４． ８和 ２６． ３）均有明显增高， Ｐ均＜０． ０１），而Ｔ组中ＧＥＪ≤ＬＥＳ上缘＋３ ｃｍ和≥－３ ｃｍ范围者（７． １和 ３９． ４）则无明显差异（ Ｐ均＞０． ０５）。研究结果表明，因 ＧＥＪ常比 ＬＥＳ上缘偏低，故以 ＧＥＪ安放电极（尤其是ＧＥＪ＞ＬＥＳ上缘 ＋ ３ｃｍ或＜－ ３ｃｍ范围者）对反流性食管炎行

To investigate the effects on the localization of pH probe in esophageal acid monitoring for patients with reflux esophagitis. 60 patients with reflux esophagitis were randomly divided into 30 cases of control group (group C ) and 30 cases of test group (group T ). Befor ambulatory 24-hr esophageal pH monitoring was performed, pH probe was respectively located at 5 cm above the upper edge of the lower esophageal sphincter (LES) with the manometry in group C and was located at 5 cm above the gastroesophageal junction with the gastroesophageal pH step-up in group T. Results: In group C and group T, no significant difference was found in the average distance of the EGJ(46±4．1 vs 46. 5±4.5 cm, P=0.8). But the average distance of the EGJ in two groups was lower 3. 0 cm than that from the nares to the upper edge of the LES in group C (46. 3±4.3 cm vs 43. 3± 3.1 cm, P= 0. 0003). The percent time of pH<4 for the total monitoring period and composite scores of subjects in group T and of subjects with the GEJ>3 cm and M-3cm range of the upper border of LES in group T were significantly higher than those of subjects in group C (8. 5 and 45. 5, 10. 0 and 99. 3 vs 4. 8 and 26. 3, respectively P <0. 01) but subjects with the GEJ<+3 cm and >- 3cm in group T (7. 1 and 39. 4) were not different (P >O. 05). The results of this study manifest: Because the place of GEJ was often lower than that of upper border of LES, pH probe was located according to GEJ (especially in subjects with the EGJ>+3 cm or < - 3cm range of the upper border of LES) when esophageal acid monitoring was performed, this may increase its monitoring results.