胃食管反流性胸痛的临床探讨  

Clinical appraisal of gastroesophageal reflux induced chest pain

作　　者：杨根妹[1] 张忠兵[2] 姚建芳[1] 尚孝堂[1] 沈建伟[2] 施斌[2] 

机构地区：[1]上海市普陀区中心医院,200062 [2]第二军医大学长征医院

出　　处：《上海医学》2004年第7期488-490,共3页Shanghai Medical Journal

摘　　要：目的　探讨胃食管反流性胸痛 (GERCP)的临床特征及其诊断和治疗。方法　对 2 7例冠状动脉造影、动态心电图和胸片正常的非心源性胸痛 (NCCP)患者进行胃镜检查及 2 4h食管 pH监测 ,并利用症状相关性概率 (SAP)分析胸痛与胃食管反流 (GER)的相关性 ,对Demeester总积分≥ 14 .72和 (或 )SAP≥ 75 %的患者进行为期 4周的奥美拉唑 (4 0mg/d ,分 2次服用 )试验性抗反流治疗。结果　 2 7例NCCP患者中 ,有 13例Demeester总积分≥ 14 .72 ,14例Demeester总积分 <14 .72中 6例SAP≥ 75 % ,这 19例患者诊断为GERCP ;应用奥美拉唑完成试验性抗反流治疗后 ,15例患者胸痛消失 ,其余 4例对试验性抗反流治疗反应较差或无效。结论　GER是不明原因胸痛的一个重要的独立原因 ,2 4h食管 pH监测结合SAP有助于GERCP的诊断 ;应用奥美拉唑试验性抗反流治疗Objective To appraise the clinical features, diagnosis and treatment of gastroesophageal reflux iuduced chest pain(GERCP). Methods A continuous ambulatory esophageal pH monitoring was performed for 24 hours in 27 cases with noncardic chest pain(NCCP), and normal ECG, Holter, coronary angiography and chest X-ray films. The symptom association probability(SAP) was adopted to analyze the correlation of chest pain with gastroesophageal reflux. The anti-reflux treatment with omeprazole(40 mg/d)was given for 4 weeks to those patients with Demeester score≥14.72 and/or SAP ≥75%. Results Altogether 27 cases, 13 showed Demeester score≥14.7 and 14<14.7, among them 6 patients with SAP≥75%. 19 out of 27 cases were diagnosed as having gastroesophageal reflux. The chest pain completely disappeared in 13 cases after antireflux treatment, little or no relief in the other 4 cases. Conclusions The gastroesophageal reflux may be an important independent factor for obscure chest pain. Demeester score as well as the SAP are beneficial to the diagnosis of GERCP. Anti-reflux treatment with omeprazole(20 mg/d)for 4 weeks is a proper valuable measure for diagnosis and treatment in patients with GERCP

关 键 词：胃食管反流性胸痛 诊断 治疗 动态心电图 胸片 

分 类 号：R571[医药卫生—消化系统]