胃食管反流病导致心肺系统急症临床分析  

Analysis of acute events of cardiorespiratory system caused by gastroesophageal reflux disease

作　　者：王梅[1] 叶丹[1] 

机构地区：[1]北京航天总医院急诊科,100076

出　　处：《中国现代医药杂志》2012年第12期16-19,共4页Modern Medicine Journal of China

摘　　要：目的探讨因胃食管反流病(GERD)所致心肺系统急症患者的临床特点以及可能的诊疗策略。方法 2006年5月～2011年5月间急诊患者37例,男17例,女20例;平均年龄(42.9±11.3)岁;症状包括心前区闷痛9例、胸骨后灼痛11例、胸痛伴左上肢放射痛5例、刺激性剧烈咳嗽3例、慢性咳嗽急性加重4例、急性喘息发作4例、突发呼吸窘迫1例。发病前情况包括饱食饮酒11例、兴奋活动8例、寒冷刺激6例、吸入异味5例、安静休息7例。所有患者来院后均即刻完善病史采集;予以吸氧,监测心率、血压,开放静脉通路,予以解痉、平喘、扩冠,改善微循环,对症治疗;同时完善常规及相关辅助检查。如需要,待症状平稳后,予以复查或进一步完善专科检查以明确诊断。确诊后予以正规治疗并定期经门急诊复查随访。结果 1例患者因声门水肿而接受气管插管及大剂量激素冲击和脱水等治疗后好转。其余患者经及时解痉、平喘、扩冠和改善微循环等治疗后,症状均明显缓解,症状持续时间25min～4h,平均2.5h。所有患者行辅助检查并完善呼吸及循环相关专科检查后排除心肺系统疾病诊断,但患者症状反复发作,后经详细追问病史并完善各项检查,其中30例胃镜检查后确诊为GERD,疾病程度包括Ⅲ级10例(33.3%)、Ⅱ级15例(50%)、Ⅰ级5例(16.7%)。行正规抑酸、促排空及粘膜保护治疗后症状改善明显,经定期复查胃镜显示疾病控制满意,29例患者治愈,5例好转,仅2例高龄患者无效。91.9%的患者随访至今,中位随访时间41个月(15～75个月),前述心肺系统急症未再次出现。结论 GERD引起的心肺系统急症在临床容易误诊误治,且在一定程度上可诱发真正的心肺系统事件发生,应引起临床医生的重视,必要时试验性治疗是可选择的诊治方法之一。Objective To analyze the clinical characteristics of acute events of cardiorespiratory system caused by gas- troesophageal reflux disease. Methods From May 2006 to May 2011,37 patients （17 males and 20 females,aged 42.9±11.3 years） with acute events of cardiorespiratory system caused by GERD were diagnosed and treated in our department. The clinical features and data of fellow-up of the patients were retrospectively reviewed, and a summarization of the strategy of diagnosis and treatment was tried. Results Except for one trachea intubation was performed for a patient with Glottis edema, the symptoms of all the other patients were relived after an emergency treatment. GERD was considered when the symptoms of these patients were recurred repeatedly, and the diagnosis was confirmed after gastroscopy was performed. By a systematic treatment for the GERD, except for only two elder patients, all the other patients were cured. And the data of fellow-up was also satisfying. Conclusion Because of the atypical and complex symptoms, the GERD is easily misdiagnosed and should attract more atten- tions of the doctors. If it is necessary, the strategy of ＂therapy as investigation＂ might be a superior methodology.

关 键 词：胃食管反流病 急症 心肺系统 心绞痛 诊断 

分 类 号：R571[医药卫生—消化系统]