慢性阻塞性肺疾病肺功能改变对胃食管反流影响  

The influence of pulmonary function changes of chronic obstructive pulmonary disease on gastroesophageal reflux

作　　者：翁俊良[1] 郑义珊 马琼凤[1] 

机构地区：[1]汕头大学医学院第一附属医院内科,广东汕头515041 [2]汕头龙湖人民医院内科

出　　处：《中国基层医药》2005年第12期1655-1657,共3页Chinese Journal of Primary Medicine and Pharmacy

基　　金：广东省科委资助项目(2003C33714)

摘　　要：目的探讨慢性阻塞性肺疾病(COPD)是否为胃食管反流(GER)加重的病因。方法对176例轻、中、重度COPD患者分三组进行肺功能、食管内24 h pH值、食管内、胃内压力和食管运动功能等检测。并研究其与COPD严重程度的相关性。结果(1)依COPD的严重程度,患者肺功能均逐步递减。(2)食管内24 h pH值,反流严重程度和COPD严重程度平行,总积分分别为(17.8±1.20)(、20.6±1.8)和(26.65±2.0)分(P<0.001)。(3)食管内和胃内测压,显示COPD三组的跨膈压分别为(11.25±1.37)(、13.65±2.52)和(16.72±1.87)mm Hg(P<0.001),与COPD的严重程度平行。(4)食管下扩约肌区(LES)的压力,依COPD严重程度直线下降,分别(19.67±3.5)(、10.72±1.5)和(4.54±2.5)mm Hg(P<0.001)。(5)食管的原发性蠕动的频率,依COPD的严重程度,逐步减少,传递速度也逐步下降。结论COPD患者的跨膈压增大、LES压力下降、食管运动功能障碍,均可导致GER。提示COPD可能是GER加重的病因。Objective To explore whether chronic obstructive puhnonary disease（COPD） can worsen gastroesophageal reflux（GER）. Methods 176 cases of patients with COPD were divided into three groups according to pulmonary air residual volume. The pulmonary functions 24-hours intraesophageal pH monitor,pressure of esophagus and stomach,and motion function of esophagus were examined in each group. And then explored the relationship between the serious degree of COPD and GER. Results （ 1 ） Pulmonary functions（ FVC, FEV1, MMEF, MVV） reduced gradually according to the serious degree of COPD. （2）24-hours intraesophageal pH monitor detected that serious level of reflux was in parallel with the serious degree of COPD. The composite scorings were （17.8 ± 1.2）, （20.6± 1.8） and （26.65±2.0） respectively in groupⅠ , Ⅱ and Ⅲ of COPD（P〈0.001）.（3）The transdiaphragmatie pressure（Pdi） in each group was （ 11.25 ± 1.37）, （ 13.65 ± 2.52） and （ 16.72 ± 1.87 ） mmHg respectively（P〈 0. 001）. It was also in parallel with the serious degree of COPD. （4）The pressure of low esophagus sphincter（PLES） were （ 19.67 ± 3.5 ）, （ 10.72 ± 1.5 ） and （ 4.54 ± 2.5 ） mmHg respectively （P 〈 0. 001 ） in each group, which was remarkably declined along with the degree of COPD. （5）The frequency and velocity of esophageal primary peristalsis were gradually decreased according to the serious degree of CDPD. Conclusioits The increase of PDl,decrease of PLES and the disorder motion function of esophagus can together cause GER. It suggests that COPD probably is one of the causes of GER.

关 键 词：胃食道反流 呼吸功能试验 慢性阻塞性肺疾病 肺功能 

分 类 号：R563.9[医药卫生—呼吸系统]