体位及吞咽食团不同对食管高分辨测压结果的影响  

Influence of position and bolus type on esophageal high-resolution manometry findings

作　　者：孟凡冬[1] 李文燕[1] 周巧直[1] 王媛[1] 吴咏冬[1] 冀明[1] 张澍田[1] 

机构地区：[1]首都医科大学附属北京友谊医院消化内科 国家消化系统疾病临床医学研究中心,100050

出　　处：《中华消化内镜杂志》2016年第10期684-688,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的通过高分辨测压（HRM）手段，探讨不同体位和不同吞咽食团对食管动力检查结果的影响。方法2014年2月至2015年10月，80例患者先后接受常规卧位液体吞咽和坐位固体吞咽这两种状态下的食管HRM检查，采用芝加哥标准对比两种方法的HRM参数。结果不同体位下，食管下括约肌静息压差异无统计学意义（P＝0.915）。完整松弛压（IRP）在卧位液体吞咽时明显低于坐位固体吞咽[3.5（1.7，7.8）mmHg（1 mmHg＝0.133 kPa）比6.5（3.1，11.4）mmHg，P〈0.01]，远端收缩积分未见统计学差异（P＝0.487）。两者食管动力综合诊断相符的有61例（76.25%），一致性尚可（Kappa＝0.634）。坐位固体吞咽状态下，19例（23.75%）患者的食管动力综合诊断发生了改变，当中有6例（7.50%）发生了重要改变。结论在常规卧位液体吞咽食管测压的基础上增加立位固体吞咽，有助于提高食管动力障碍的检出率。Objective To investigate the influence of position and bolus type on esophageal motility by using high-resolution manometry （HRM）. Methods A total of 80 patients were recruited in this study from February 2014 to October 2015. HRM testing was performed with water and solid swallows in supine and the upright positions respectively. HRM plots were analyzed according to Chicago classification and compared between postures and boluses. Results There was no difference in the mean resting lower esophageal sphincter pressure （LESP） between supine and upright position（ P= 0.915 ）.The integrated relaxation pressure （IRP） was lower with water swallows in supine position than solid swallows in the upright position [ 3.5 （1.7,7.8） mmHg （ 1 mmHg = 0.133 kPa ） VS 6. 5 （ 3.1,11.4 ） mmHg, P 〈 0.01] but distal contractile integral （DCI） was the same （P = 0. 487 ）.The diagnnsis of esophageal motility disorders was concordant be- tween water swallows and solid swallows in 61 cases（ 76. 25% ） and the overall consistency in diagnosis was acceptable （Kappa=0. 634）. The solid swallow in upright positinn suggested a different diagnosis from the water swallows in supine position in 19 patients （ 23.75% ）. A significantly different diagnosis was changed in 6 cases （ 7. 50% ）. Conclusion Inclusion of solids swallows in the upright position into HRM studies may increase the detection rate of esophageal motility abnormalities.

关 键 词：高分辨率食管测压 测压参数 不同食团 不同体位 

分 类 号：R571[医药卫生—消化系统]