食管源性胸痛的联合诊断和治疗(附44例报告)

The application of esophageal manometry and ambulatory esophageal pH monitoring test in the esophageal chest pain:44 cases report

目的 探讨食管动力学检测、2 4h食管pH及动态心电图同步监测在食管源性胸痛 (ECP)诊断中的价值。方法 对 4 4例反复发作胸痛病人进行食管动力学检测、2 4h食管pH及动态心电图监测。根据检查结果 ,给予相应治疗 ,并观察近期效果。结果 2 8例为ECP(6 3 6 % ) ,其中 18例存在胃食管反流 (40 9% ) ,10例弥漫性食管痉挛 (2 2 7% ) ;2例心源性胸痛 (4 5 % ) ;未能明确原因 14例 (31 9% )。12例ECP病人给予吗丁啉加洛赛克治疗后胸痛明显缓解 ,食管动力学障碍改善 ,反酸得到控制。结论 对反复发作胸痛病人行食管动力学检查、2 4h食管pH监测、动态心电图检查 ,能有效判断胸痛原因 ,为治疗提供指导依据。吗丁啉加洛赛克系统治疗ECP ,效果满意 ,但其长期效果尚有待于进一步观察。

Objective: To explore the value of esophageal manometry, 24-hour ambulatory esophageal pH monitoring test, 24-hour ambulatory electrocardiogram in the diagnosis of esophageal chest pain (ECP). Methods: The manometry, 24-hour pH monitoring and 24-hour electrocardiogram were performed in 44 patients with chest pain. All patients were treated differently according to the results. Results: ECP was found in 28 patients (63。6%), include 18 gastroesophageal reflux (40。9%) and 10 diffuse esophageal spasm (22。7%). Cardiogenic chest pain was in 2 patients (4。5%) and 14 patients with undetermined chest pain (31。9%). Twelve patients with ECP were treated with motilium and Losec, their symptom improved significantly and manometry and pH study were also improved. Conclusion: Esophageal function tests may help to determine the origin of chest pain and provide the instruction on the treatment. The curative effect with the use of Losec and motilium is perfect, but the long-term result should be made with the further observation.