24 h pH/阻抗监测在胃食管反流性咳嗽中的应用价值

目的明确24 h pH联合阻抗监测在胃食管反流性咳嗽(GERC)中的应用价值。方法回顾性选取2013年8月至2014年12月解放军总医院第六医学中心消化科专病门诊就诊的伴有慢性咳嗽的胃食管反流病(GERD)患者116例,并根据24 h pH/阻抗监测结果将符合GERC诊断标准的患者定为GERC组,选取同期体检的健康志愿者30例设为对照组,所有受试者均进行胃镜检查,再进行24 h pH联合阻抗监测,记录24 h pH/阻抗监测参数。确诊的GERC患者均给予抑酸、促胃肠动力治疗,合并碱反流者给予利胆治疗,疗程12周。记录GERC患者治疗前、治疗后4周、8周、12周胃食管反流病调查(GERD-Q)量表、咳嗽症状积分、反流症状积分、莱斯特咳嗽问卷(LCQ)量表评分变化。结果24 h pH/阻抗GERC诊断率(82.8%)明显高于单纯24 h pH GERC诊断率(54.3%)(P<0.01)。GERC组反流时间>5min的次数,pH值<4的反流次数,总、立、卧位状态pH值<4的时间占监测时间的比例,最长反流时间及DeMeester评分均高于对照组(P<0.05);立、卧位状态下GERC组与对照组的液体、气体及混合反流次数存在统计学差异(P<0.05);立、卧位状态下两组间的酸、弱酸、弱碱反流次数有统计学差异(P<0.05);GERC组的近端反流次数占总反流次数明显高于对照组的(57.93%vs 20.39%)(P<0.01);抗反流治疗后GERC患者的GERD-Q积分、咳嗽症状积分、反流症状积分逐渐下降,而LCQ积分逐渐上升,差异有统计学意义(P<0.05)。结论24 h pH联合阻抗监测的GERC诊断率明显高于单纯pH监测法,可明确反流物的酸碱性、物理性质、反流高度及运动方向,同时指导GERC患者的治疗,达到提高疗效的目的,为GERC患者的规范化诊治提供了重要参考依据。

24h食管pH／阻抗监测在胃食管反流病中的应用与护理

目的探讨并总结24h食管pH／阻抗监测在胃食管反流病（GERD）中的应用效果与护理体会。方法利用24h食管pH／阻抗监测技术，对68例患者进行监测及护理。结果66例一次置管成功，2例二次置管成功。置管后无鼻咽、胃部损伤以及误吸等并发症。置管前后每例患者呼吸、脉搏、血压的检测结果无显著差异（P〉0．05）。本组患者确诊为GERD者59例（86．76％），其中酸反流为主者34例（50％），弱酸反流为主者23例（33．82％），非酸反流为主者2例（2．94％）。结论24h食管pH值／阻抗监测是安全、有效、无创、客观的检查技术，可以更加准确的诊断GERD。正确的插管方法及良好的护理配合是提高检查成功率的必要措施。

Reflux characteristics of 113 GERD patients with abnormal 24-h multichannel intraluminal impedance-pH tests

Objective： To analyze reflux parameters by means of combined multichannel intraluminal impedance and pH （MII-pH） monitoring in patients with gastroesophageal reflux disease （GERD） symptoms off medication, and to find the reflux characteristics of Chinese GERD patients and the influences of gender, age, body posture, and body mass index （BMI） on gastroesophageal reflux （GER）. Methods： Between Dec. 2008 and May 2014, 125 patients with typical GERD symptoms were subjected to 24-h MII-pH monitoring. Twelve patients with normal MII-pH profiles were not considered for analysis. The reflux parameters of 113 GERD patients with abnormal Mll-pH results were analyzed. Results： （1） DeMeester scores were above the normal range in 46.90% （53/113） of GERD patients. Weakly acidic refluxes were prevalent in GERD patients, and the frequency of abnormal weakly acidic reflux was 75.22% （85/113）. The frequencies of abnormal symptom index （SI） and symptom association probability （SAP） were 19.47% （22/113） and 14.16% （16/113）, respectively. （2） The frequencies of DeMeester scores, the %time at pH〈4, and the numbers of reflux episodes and of long reflux episodes 〉5 min were significantly higher in male patients than in female patients. （3） The %time at pH〈4 was much higher during upright periods than during supine periods. During supine periods, 31.86% （36/113） of GERD patients had delayed bolus clearance time, compared with 19.47% （22/113） during upright periods. （4） The number of abnormal DeMeester scores, %time at pH〈4, and the number of acid refluxes during upright periods were significantly higher in obese GERD patients than in GERD patients with a normal BMI. Over- weight GERD patients also had many more acid refluxes during upright periods than GERD patients with a normal BMI Conclusions： Weakly acidic refluxes were prevalent in Chinese GERD patients. The factors male, gender, upright position, obesity （BMI〉25）, but not age, may increase the frequency and severity of GER.