胃镜检查中呕吐反应与消化不良症状的关系

Relationship between vomiting reflex during endoscopy and upper gastrointestinal symptoms

目的:探讨经口胃镜检查患者中呕吐反应的发生率及其影响因素.方法:将2012-08/2014-01在六盘水市水矿总医院门诊行胃镜检查的428例受检者按是否出现呕吐反应分为呕吐反应阳性组和呕吐反应阴性组,对两组受检者行胃食管反流病症状频率量表(Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease,FSSG)评分,并统计受检者一般情况及其他临床特点进行分析.结果:428例受检者中230例(53.7%)出现呕吐反应(5.6次±2.3次).反应阳性组年龄显著低于反应阴性组(t=5.59,P<0.01).胃食管反流症状与消化不良症状发生率均显著高于反应阴性组(χ2=35.60、45.64,P<0.01),胃食管反流症状评分和消化不良症状评分也显著高于反应阴性组(t=3.11、5.24,P<0.01).胃镜检查中食管裂孔疝的发生率在反应阳性组中也更高(χ2=19.30,P<0.01).多因素L o g i s t i c回归分析表明年龄、食管裂孔疝、胃食管反流症状、消化不良症状与呕吐反应的发生有显著的相关性(OR值=0.45、3.89、2.54、2.70,P<0.05).以F S S G量表中消化不良症状得1分为截断值,预测呕吐反应的敏感性为65%,特异性为59%.结论:胃镜检查中呕吐反应的发生与上消化道症状有关,其中消化不良症状的相关性更显著.

AIM：To explore the incidence of the vomiting reflex during endoscopy and related factors,especially upper gastrointestinal symptoms.METHODS：Subjects included 428 adults who were assigned into a vomiting-reflexpositive group or a vomiting-reflex-negative group according to the presence of vomiting reflex or not during clinic endoscopy between August 2012 and January 2014.Based on a questionnaire survey using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease（FSSG）,scores of symptoms（dyspepsia and gastroesophageal reflux） as well as the general factors and clinical factors of all subjects were recorded.RESULTS：Approximately 53.7%（230/428） of subjects developed vomiting reflexes（5.6 times ±2.3 times）.This reflex-positive group was significantly younger than the reflex-negative group（t = 5.59,P〈0.01）.The incidence of gastroesophageal reflux and dyspepsia in the reflex-positive group was significantly higher than that in the reflex-negative group（χ~2 =35.60,45.64,P〈0.01）.The dyspepsia score and gastroesophageal reflux score in the reflexpositive group were significantly higher than those in the reflex-negative group（t = 3.11,5.24,P〈0.01）.The incidence of esophageal hiatal hernia during esophagogastroduodenoscopy（EGD） was significantly higher in the reflexpositive group（χ~2 = 19.30,P〈0.01）.Multivariate logistic regression analysis also showed a significant correlation between these four factors and the occurrence of vomiting reflexes.Using an FSSG dyspepsia score of 1as the cut-off offered a 65%sensitivity and a59%specificity for predicting the occurrence of vomiting reflexes.CONCLUSION：Upper gastrointestinal symptoms,especially dyspepsia symptoms,are related to the presence of vomiting reflexes during EGD.