pH电极位置对反流性食管炎酸监测的影响

Effects of the pH probe location on esophageal acid monitoring for patients with reflux esophagitis

目的探讨 pH电极位置对反流性食管炎酸度监测的影响。方法 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 5cm处； T组 30例用 pH梯度法将电极放于胃食管连接处 (GEJ)上方 5cm处。连续 24h pH监测。 结果 C与 T组前鼻孔至 GEJ平均距离 (46.2± 4.1cm与 46.5± 4.5cm)无明显差异 (P=0.8)。两组 GEJ平均距离 (46.3± 4.3cm)比 C组前鼻孔至 LES上缘平均距离 (43.3± 3.1cm)低 3.0cm(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± 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± 3cm范围者 (7.1和 39.4)则无明显差异 (P均 >0.05)结论因 GEJ常比 LES上缘偏低，故以 GEJ安放电极 (尤其是 GEJ>LES上缘± 3cm范围者 )对反流性食管炎行 pH监测时，这可能会扩大酸监测结果。

Objective To investigate the effects of the pH probe location on esophageal acid monitoring for patinets with reflux esophagitis.Methods Sixty patients with reflux esophagitis were randomly divided into control group(group C,30 cases) and test group(group T,30 cases.)Before ambulatory 24－ hr esophageal pH monitoring was performed,pH probe was respectively located 5 cm above the upper edge of the lower esophageal sphincter(LES)with the manometry in group C and was located 5cm above the gastroesophageal juction(EGJ)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(46.2± 4.1cmvs.46.5± 4.5cm,P=0.8),But the average distance of the EGJ in two groups was 3.0cm lower than that from the nares to the upper dege of the LES in group C(46.3± 4.3cm vs.43.3± 3.1cm,P=0.0003).The fraction time of pH<4 for the total monitoring period and composite scores of subjects in group T and of subjects with the GEJ >± 3cm range of the upper border of LES in group T were significantly higher than those 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≤± 3cm in group T(7.1 and 39.4)were not different (P >0.05).Conclusion 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 >± 3cm range of the upper border of LES)when esophageal acid monitoring was performed,this may exaggerate the monitoring results.