24小时食管多通道腔内阻抗联合pH监测技术在早产儿中的应用

Role of the twenty-four-hour esophageal multichannel intraluminal impedance-pH monitoring in preterm infants

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.

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.