伴或不伴吞咽困难的胃食管反流病患者食管动力特征  

Esophageal motility characteristics in gastroesophageal reflux disease patients with or without dysphagia

作　　者：史以超[1] 王潇潇[1] 艾洁[1] 孙刚[1] 王巍峰[1] 彭丽华[1] 杨云生[1] 

机构地区：[1]解放军总医院消化科,北京100853

出　　处：《中华消化杂志》2016年第10期676-680,共5页Chinese Journal of Digestion

摘　　要：目的 应用食管高分辨率测压联合24 h食管pH监测,探讨GERD伴或不伴吞咽困难患者的食管动力特点.方法 收集2012年8月至2015年11月具有反酸、胃灼热症状并完成24 h食管pH监测确诊为GERD的患者.根据GERD患者是否合并吞咽困难,进一步分析GERD伴或不伴吞咽困难患者的食管动力差异.统计学分析采用t检验、卡方检验或Fisher确切概率法.结果 共194例患者经24 h食管pH监测确诊为GERD并同期完成食管测压,其中GERD伴吞咽困难患者17例（8.8％）,不伴吞咽困难患者177例（91.2％）.GERD伴吞咽困难患者的食管动力障碍分型以重度食管动力障碍为主（5/17）,而GERD不伴吞咽困难患者以轻度食管动力障碍为主（10.2％,18/177）.GERD伴吞咽困难患者的食管综合松弛压、食管下括约肌（LES）残余压,以及LES上沿以上3.0、11.0 cm处收缩幅度均高于伴吞咽困难者[分别为（9.70±0.98） mmHg（1 mmHg=0.133 kPa）比（7.02±0.30） mmHg,（12.75±1.35） mmHg比（9.18±0.42） mmHg,（106.80±11.97） mmHg比（70.82±3.48） mmHg,（82.66±10.70） mmHg比（56.93±3.11） mmHg],差异均有统计学意义（t=2.601、2.488、2.887、2.308,P均＜0.05）.GERD伴吞咽困难患者食管远端收缩积分明显高于不伴吞咽困难者[（2 128.94±310.47） mmHg· cm·s比（1 029.88±90.16） mmHg·cm·s],差异有统计学意义（t=3.400,P=0.001）,而食管上括约肌残余压明显低于不伴吞咽困难者[（2.84±1.21） mmHg比（6.18±0.38）mmHg],差异有统计学意义（t=-2.650,P=0.009）.结论 GERD伴吞咽困难患者的食管动力障碍较不伴吞咽困难者重.食管高分辨率测压能够为GERD患者提供食管动力学的客观依据,对GERD的诊断和治疗起指导作用.Objective To investigate esophageal motility characteristics in gastroesophageal reflux disease （GERD） patients with or without dysphagia by high-resolution manometry and 24 h esophageal pH monitoring.Methods From August 2012 to November 2015,GERD patients with symptoms of acid reflux and heart burn who received 24 h esophageal pH monitoring were collected.The differences in esophageal motility were further analyzed between the GERD patients with dysphagia and without dysphagia.Student＇s t test,x2 test and Fisher＇s exact test were performed for comparison analysis.Results A total of 194 patients received 24 h esophageal pH monitoring and diagnosed as GERD,and at the same period completed esophageal high-resolution manometry.Among them,there were 17 GERD patients （8.8%） with dysphagia and 177 patients （91.2%） without dysphagia.The main classification of esophageal motility disorder of GERD patients with dysphagia was severe esophageal motility disorders （5/ 17）,but the motility type of GERD patients without dysphagia patients mainly was mild esophageal motility disorders （10.2%,18/177）.The integrated relaxation pressure,residual pressure of lower esophageal sphincter （LES）,and contraction range at 3 cm and 11 cm above LES of GERD patients with dysphagia were all higher than those of patients without dysphagia （（9.70±0.98） mmHg （1 mmHg=0.133 kPa） vs （7.02±0.30） mmHg,（12.75±1.35） mmHg vs （9.18±0.42） mmHg,（106.80± 11.97） mmHg vs （70.82±3.48） mmHg,（82.66±10.70） mmHg vs （56.93±3.11） mmHg）,and the differences were statistically significant （t=2.601,2.488,2.887,2.308,all P〈0.05）.Distal esophageal contraction integral score of GERD patients with dysphagia was significantly higher than that of GERD patients without dysphagia （（2 128.94±310.47） mmHg · cm · s vs （1 029.88±90.16） mmHg · cm · s）,and the difference was statistically significant （t =3.400,P =0.001）.However,residual pressure of upper esophageal sphincter was si

关 键 词：胃食管反流病 高分辨率食管测压 食管动力障碍 

分 类 号：R571[医药卫生—消化系统]