贲门失弛缓症患者24h食管pH监测结果分析  

Analysis of 24-hour esophageal pH monitoring outcomes in achalasia

作　　者：张游[1] 令狐恩强[1] 彭丽华[1] 王潇潇[1] 

机构地区：[1]解放军总医院消化内科,北京100853

出　　处：《中华胃肠内镜电子杂志》2014年第1期7-10,共4页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

摘　　要：目的了解贲门失弛缓症患者在经口内镜下食管肌切开术（peroralendoscopicmyotomy，POEM）前24h酸暴露情况。方法对2011年7月至2013年5月就诊于解放军总医院消化内镜中心的85例贲门失弛缓症患者，采用便携式24h食管pH记录仪进行24h食管pH监测，统计分析胃食管反流的发生率及各项pH观察指标的阳性率，包括：pH〈4的总时间（％）、立位pH〈4的总时间（％）、卧位pH〈4的总时间（％）、pH〈4的反流次数、24h内pH〈4超过5min的反流次数。结果85例患者术前24h食管pH监测提示胃食管反流病发生率为21．18％（18／85），其中有16例患者仅积分符合胃食管反流病，其症状与反流不相关（〈95％），男女患者之间比较反流发生率无明显差异（x。=0．49，P〉0．05）。各项指标诊断贲门失弛缓症患者出现病理性酸反流的阳性率分别为：pH〈4的总时间（％）阳性率为21．18％（18／85），立位pH〈4的总时间（％）为15．29％（13／85），卧位pH〈4的总时间（％）为21．18％（18／85），pH〈4的反流次数为11．76％（10／85），24h内食管pH〈4超过5min的反流次数为18．82％（18／85），最长反流持续时间（rain）为23．52％（20／85）。结论贲门失弛缓症患者在POEM术前就可能存在胃食管反流病，但其发生的原因有待进一步研究。Objective To observe 24 hours esophageal acid exposure of patients with achalasia who have not yet received treatment with POEM. Methods Esophageal pH of 85 patients with achalasia were measured by portable 24 hour dynamic monitoring instrument in our digestive endoscopy center from July 2011 to May 2013. The incidence of gastroesophageal reflux disease （GERD） and the positive rate of each indicator about esophageal reflux are statistically analyzed, including percentage of the total time of pH〈4, percentage of uptight total time of pH〈4, percentage of supine total time of pH〈4, number of reflux episode of pH〈4 and number of reflux episode of pH〈4 lasting more than five minutes during 24 h. Results 24 hours esophageal pH monitoring showed that the incidence of gastroesophageal reflux disease （GERD） in 85 patients with achalasia before treatment with POEM was 21.18% （18/85） , of whom there were only 16 patients whose only DeMeester score complied with GERD, with no significant difference of the reflux rate between men and women （X2=0.49,P〉0.05） . The positive rate of each pH indicator for diagnosis of GERD in patients with achalasia are listed as follows： total time of pH 〈4 （%） was 21.18% （18/85）, uptight total time of pH〈4 （%） was 15.29% （13/85）, supine total time of pH〈4 （%） was 21.18% （18/85）, number of reflux episode （pH〈4） is 11.76% （10/85）, number of reflux episode （pH〈4） lasting more than five minutes during 24 hours was 18.82% （18/85） and the longest reflux duration （rain） was 23.52% （20/85）. Conclusions Patients with aehalasia might have suffered from GERD before they undergo the treatment with POEM, however, the reasons for its occurrence need further study.

关 键 词：贲门 食管失弛症 胃食管反流 氢离子浓度 

分 类 号：R571[医药卫生—消化系统]