体表穴位电刺激对45例难治性胃食管反流病患者食管动力的影响

Effects of transcutaneous electro acupuncture stimulation on esophageal motility of forty-five patients with refractory gastroesophageal reflux disease

目的 通过食管高分辨率测压（HRM）观察体表穴位电刺激（TEA）对难治性胃食管反流病（RGERD）患者食管动力的影响，为RGERD的治疗提供新的方法。 方法 纳入2014年2月至2015年6月就诊的45例RGERD患者，采用TEA仪对其内关穴和足三里穴进行电刺激治疗，治疗前后进行食管HRM，比较食管下括约肌压力（LESP）、远端收缩积分（DCI）、食管下括约肌（LES）以上7 cm处波幅、LES以上3 cm处波幅、食管体部速度和收缩前沿速度等食管动力相关参数的变化。统计学分析采用配对样本t检验。 结果 45例RGERD患者根据LESP值，分成LES低压组（10例）和LESP正常组（35例）；根据食管动力参数，分成食管动力障碍组（25例）和食管动力正常组（20例）。予TEA治疗后，LES低压组LESP为（14.83±4.17） mmHg（1 mmHg＝0.133 kPa），高于治疗前的（9.54±2.42） mmHg，差异有统计学意义（t＝4.92，P＝0.001）；食管动力障碍组LESP为（19.04±5.91） mmHg，高于治疗前的（16.20±6.09） mmHg，差异有统计学意义（t＝4.92，P＝0.001）；LESP正常组和食管动力正常组治疗前后的LESP差异均无统计学意义（P均〉0.05）。治疗后，食管动力障碍组DCI为（530.76±215.53） mmHg·cm·s，高于治疗前的（363.92±279.17） mmHg·cm·s，差异有统计学意义（t＝2.86，P〈0.05）；食管动力障碍组治疗前后LES以上7 cm处波幅、LES以上3 cm处波幅、食管体部速度和收缩前沿速度差异均无统计学意义（P均〉0.05）。食管动力正常组治疗前后各项食管动力参数差异均无统计学意义（P均〉0.05）。 结论 TEA可提高RGERD食管动力障碍患者的LESP和DCI，改善食管整体收缩力度，提高食管廓清能力。

Objective To investigate the effects of transcutaneous electro acupuncture stimulation （TEA） on esophageal motility of patients with refractory gastroesophageal reflux disease （RGERD） by high resolution manometry （HRM）, and to provide a new treatment option for RGERD. Methods From February 2014 to June 2015, a total of 45 patients with RGERD were enrolled. TEA instrument was used for electro acupuncture stimulation at the points of Zusanli and Neiguan. HRM was carried out before and after treatment. The changes of HRM parameters such as lower esophageal sphincter pressure （LESP）, distal contractile integral （DCI）, and amplitude of 3 cm, 7 cm above lower esophageal sphincter （LES） , esophageal body velocity and contractile front velocity （CFV） were also compared. The paired-samples t test was performed for statistical analysis. Results According to LESP value, 45 patients were divided into low LESP group （10 patients） and normal LESP group （35 patients）. According to parameter of esophageal motility function, patients were divided into esophageal dysmotility group （25 patients） and normal esophageal motility group （20 patients）. After TEA treatment, the LESP of lower LESP groupwas （14.83 ±4. 17） mmHg （1 mmHg = 0. 133 kPa）, which was higher than that before treatment （（9. 54± 2.42） mmHg）, and the difference was statistically significant （t=4.92, P=0. 001）. LESP of esophageal dysmotility group was （19.04 ±5.91） mmHg, which was higher than that before treatment （（16.20± 6.09） mmHg）, and the difference was statistically significant （t= 4. 92, P=0. 001）. There was no statistically significant difference in LESP of normal LESP group and normal esophageal motility group before and after treatment （both P〉0.05）. After treatment, DCI of esophageal dysmotility group was （530. 76 ± 215.53）mmHg.cm. s, which was higher than that before treatment （（363. 92 ± 279.17） mmHg· cm· s） , and the difference was statistically significant （t=2.86, P〈0.05）. There was no statistically significant difference in esophageal body velocity, amplitude of 3 cm, 7 cm above LES and CFV before and after treatment （all P〉0.05）. There was no statistically significant difference in all of the esophageal motility parameters in normal esophageal motility group before and after treatment （all P〉 0. 05）. Conclusion TEA can increase LESP and DCI in R（;ERD patients with esophageal motility dysfunction, improve contraction of entire esophagus and raise esophageal clearance capacity.