24小时食管多通道腔内阻抗联合pH监测与足月儿胃食管反流症状关系研究  

Gastroesophageal reflux： twenty-four-hour esophageal multichannel intraluminal impedance-pH monitoring in full term newborns

作　　者：朱家叶 姜毅[1] 侯新琳[1] 汤泽中[1] 周丛乐[1] 刘黎黎[1] 孙国玉[1] Zhu Jiaye, Jiang Yi, Hou Xinlin, Tang Zezhong, Zhou Congle, Liu Lili, Sun Guoyu(Department of Pediatrics, Peking University First Hospital, Belting 100034, Chin)

机构地区：[1]北京大学第一医院儿科,100034

出　　处：《中华新生儿科杂志（中英文）》2018年第2期94-98,共5页Chinese Journal of Neonatology

摘　　要：目的探讨足月新生儿胃食管反流（gastroesophageal reflux，GER）临床特点及相关临床症状与24 h食管多通道腔内阻抗联合pH（multichannel intraluminal impedance－pH，MII－pH）监测到反流的相关性。方法回顾性收集2016年11月至2017年12月我院新生儿病房收治的有GER症状并完成24 h食管MII－pH监测的足月新生儿，根据24 h食管MII－pH监测到的反流次数是否〉93次分为病理性GER组和生理性GER组。对比两组临床特点和24 h食管MII－pH监测结果，分析反流症状与24 h食管MII－pH监测到反流的相关性。结果共纳入有GER症状的患儿31例，开始24 h食管MII－pH监测日龄中位数7（2～28） d。经24 h食管MII－pH监测确诊病理性GER 15例，生理性GER 16例，病理性GER检出率48.4%。主要临床症状包括反复呕吐12例，奶后异常哭闹9例，奶后血氧饱和度下降6例，青紫、可疑惊厥等奶后发作性事件2例，反复呕吐伴其他症状2例。24 h食管MII－pH监测显示新生儿GER以酸反流和弱酸反流为主，病理性GER组24 h总酸反流中位数52（7～80）次，总弱酸反流中位数58（19～114）次；生理性GER组24 h总酸反流中位数36（3～55）次，总弱酸反流中位数35（6～55）次。病理性GER组总反流、餐前弱酸反流、餐后弱酸反流、总弱酸反流和液体反流次数均明显多于生理性GER组，差异有统计学意义（P〈0.05）。两组总酸反流、餐前酸反流和餐后酸反流次数差异无统计学意义（P〉0.05）。出现呕吐、奶后发作性事件、奶后异常哭闹、奶后血氧饱和度下降患儿的反流症状相关指数阳性率分别为14/14、3/3、6/9和2/6，提示呕吐和奶后发作性事件与GER相关性较高，奶后异常哭闹和奶后血氧饱和度下降与GER部分相关，心动过缓与反流事件无关。结论足月新生儿病理性GER反流以酸反流、弱酸反流和液体反流为主，24 h食管MII－pH监测可用于诊断新生ObjectiveTo study the characteristics of gastroesophageal reflux （GER） in term neonates and the association between the reflux behaviors and gastroesophageal reflux events by multichannel intraluminal impedance-pH monitoring retrospectively.MethodFull term neonates suspected to have gastroesophageal reflux, admitted to neonatal ward of our Hospital from November 2016 to December 2017 were enrolled for the study. All underwent 24-hour esophageal multichannel intraluminal impedance-pH （24 h MII-pH） monitoring. They were assigned into physiologic GER group and pathologic GER group. Data of demographic characteristics, clinical symptoms, 24 h MII-pH results and indecies for evaluating the association between symptoms and reflux events were collected and analyzed.ResultA total of 31 cases were enrolled. The median age of starting 24 MII-pH monitoring was 7 days （range from 2 to 28 days）. 15 cases were diagnosed with pathologic GER （48.4%）, and 16 cases were diagnosed with physiologic GER. The symptoms and signs were persistent vomiting, incessant crying, desaturation （oxygen desaturation） and unexplained transient events （including cyanosis or suspected seizure）, case number was 12, 9, 6, 2, and 1 respectively. In the pathologic group, the median of total acid reflux 52 （7 to 80）, total weakly acidic reflux 58 （19 to 114）; In the physiologic group was 36 （3 to 55）, 35 （6 to 55） respectively. The neonates in pathologic group had more acidic reflux （both before and after feeding）, total weak acid reflux and liquid reflux than physiological GER group, which showed statistical significance （P〈0.05）. While there was no significant difference in acid reflux time of total, before feeding and after feeding （P〉0.05）. It was proved that the percentage of positive symptom indices of vomiting, postprandial transient events, incessant crying after feeding, and desaturation associated with GER were 100%, 100%, 66.7% and 33.3% retrospectively, which indicate that postprandial t

关 键 词：胃食管反流 多通道腔内阻抗监测 呕吐 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]