伊托必利对食管运动障碍NERD患者症状及食管动力的影响  

The Effect of Itopride on Reflux Symptom and Esophageal Motility in Cases of Non-erosive Reflux Disease with Dysmotility

作　　者：涂蕾[1] 向雪莲[1] 陈文妹[1] 谢小平[1] 侯晓华[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院消化科,武汉430022

出　　处：《临床消化病杂志》2011年第6期323-326,共4页Chinese Journal of Clinical Gastroenterology

摘　　要：目的研究伊托必利对伴有食管运动障碍的非糜烂性反流病(NERD)患者症状及不同吞咽模式下食管运动功能的影响。方法按标准选取具有典型胃食管反流症状及食管运动障碍的NERD患者34例,评估其胃食管反流症状,行不同物理性质食团(10次5 ml液体、10次胶体吞咽、10次2×2×2 cm固体吞咽)下高分辨率食管测压,给予伊托必利50 mg tid,对比2周治疗前后胃食管反流症状改善情况和各种吞咽模式下食管动力的改变。结果 (1)与治疗前相比,伊托必利可降低胃食管反流各单项症状及总症状积分(32.1±10.3 vs 8.2±2.9,P=0.000)。(2)降低NERD患者下食管括约肌(LES)压力的异常率(64.7%vs 29.4%,P=0.004),显著提高LES低下患者的压力值(5.4±2.6 mmHg vs 9.2±4.4 mmHg,P=0.003)。(3)增加不同食团吞咽时食管近、中、远段压力及远段食管收缩积分(P值均<0.05),对波峰起始速度、收缩前沿速度无明显影响(P值均>0.05)。(4)提高不同食团吞咽时的吞咽成功率,降低体部运动功能障碍数(P值均<0.05)。结论伊托必利可有效改善NERD患者的胃食管反流症状,部分改善食管运动障碍,对不同吞咽模式的动力影响有不同。Objective To investigate the efficacy of itopride on reflux symptoms in non-erosive reflux disease（NERD）patients with esophageal motor abnormalities.Methods 34 NERD patients with esophageal motor abnormaliftes who had typical gastroesophageal reflux symptoms were enrolled in trial.Subjects received itopride 50 mg tid.for 14 days.Symptoms,including heartburn,regurgitation,chest pain and dysphagia,were rcoorded to evaluate the effect of itopride.The esophageal motility was demonstrated by high resolution manometry（HRM,Manscan 360TM,Given Imaging）before and after itopride therapy.Each patient were given 10 liquid swallows（5 ml physiological saline each）,10 paste swallow,followed by 10 solid swallows（steamed bread,2×2×2 cm 3 cach）.All scored symptoms and esophageal funotion was determined in pre-treatment of itoptide as baseline.Result（1）Compared with baseline,the significant decrease in the total score of gastroesophageal reflus symptoms（32.1±10.3 vs 8.2±2.9,P=0.000,）was noted with 14-days itopride.The score of every recorded symptom was lower than baseline（all P0.05）.（2）The patients with low lower esophageal sphincter pressure were increased with itopride treatment（5.4±2.6 mmHg vs 9.2±4.4 mmHg,P=0.003）,while there were no stadstical significance of the uper esophageal sphincter pressure.（3）The esophagus body peristalsis amplitude were higher than baseline in different swallowing（all P0.05）,the distal contractile integral in all type bolus swallow were increased with itopride treatment（all P0.05）,the contractile front velocity of peristaltic wave in different bolus were no difference between before and after therapy.（4）The achievement ratio of water and solid swallows were highcr than baseline（all P0.05）.Conclusion The symptoms related with gastroesphageal reflux are improved after 2-weeks mosapride therapy,and esophageal dysmotility is normalized in some paremeters in the patients with NERD.

关 键 词：非糜烂性反流病 伊托必利 高分辨食管测压 不同食团 治疗 

分 类 号：R571[医药卫生—消化系统]