小儿胃食管反流的食管pH值监测及胃贲门角的超声观察  

Esophageal pH value monitoring of gastroesophageal reflux in children and ultrasound observation of gastric cardia angle

作　　者：杨云飞 吕兴锟 车清 孙巍 张文缙 侯跃会 钱云[4] YANG Yunfei;LYU Xingkun;CHE Qing;SUN Wei;ZHANG Wenjin;HOU Yuehui;QIAN Yun(Ultrasound Department,the Seventh People′s Hospital of Hebei Province,Baoding,Hebei,073000;Department of Electrocardiograph,the Seventh People′s Hospital of Hebei Province,Baoding,Hebei,073000;Department of Ultrasound,Dingzhou People′s Hospital of Hebei Province,Baoding,Hebei,073000;Department of Cardiology,the Seventh People′s Hospital of Hebei Province,Baoding,Hebei,073000)

机构地区：[1]河北省第七人民医院超声科,河北保定073000 [2]河北省第七人民医院心电图科,河北保定073000 [3]河北省定州市人民医院超声科,河北保定073000 [4]河北省第七人民医院心内科,河北保定073000

出　　处：《实用临床医药杂志》2022年第9期80-84,共5页Journal of Clinical Medicine in Practice

基　　金：河北省2020年度医学科学研究课题计划项目(20200622)。

摘　　要：目的探讨24 h食管动态pH值监测及超声观察胃贲门(His)角对小儿胃食管反流(GER)的诊断价值。方法选取收治的疑似小儿胃食管反流患儿188例为研究对象,患儿均行超声检查测量His角,同时动态监测24 h食管pH值,分析GER的危险因素,并以受试者工作特征(ROC)曲线评估His角及24 h食管pH值对GER的诊断价值。结果188例疑似GER患儿采用Boix-Ochoa标准进行评估,包括病理性GER 142例(GER组),非GER 46例(非GER组)。GER组患儿的His角、pH值<4反流总时间比、站立位pH值<4反流时间百分比、卧位pH值<4反流时间百分比、平均反流周期数、反流持续时间≥5 min次数及最长反流持续时间均大于或长于非GER组,差异有统计学意义(P<0.05)。Logistic回归分析显示,病程为GER发生的保护因素(OR=0.075,P<0.05),呕吐、His角、pH值<4反流总时间比、平均反流周期数、反流持续时间≥5 min次数、最长反流持续时间长为GER发生的危险因素(OR=3.609、1.221、8.600、1.124、46.136、1.574,P<0.05)。ROC曲线结果显示,His角、pH值<4反流总时间比、平均反流周期数、反流持续时间≥5 min次数、最长反流持续时间预测GER的曲线下面积(AUC)分别为0.912、0.998、0.963、0.988、0.986。结论超声检查下测量食管His角及24 h食管动态监测pH值对GER的诊断价值高,可作为GER筛查的有效方法。Objective To explore the diagnostic value of 24 h esophageal dynamic pH value monitoring and ultrasound observation of gastric cardia(His)angle in children with gastroesophageal reflux(GER).Methods A total of 188 children with suspected gastroesophageal reflux in children were selected as research objects.All children underwent ultrasonic examination to measure His Angle,and 24 h esophageal pH value was dynamically monitored to analyze the risk factors of GER,and the diagnostic value of His Angle and 24 h esophageal pH value for GER was evaluated by receiver operating characteristic(ROC)curve.Results Of 188 children with suspected GER,there were 142 cases(GER group)with GER and 46 cases(non-GER group)without GER according to Boix-Ochoa standard assessment.His angle,pH value<4 total reflux time ratio,pH value<4 reflux time percentage in standing position,pH value<4 reflux time percentage in lying position,average number of reflux cycles,times of reflux duration≥5 min,and the longest reflux duration were significantly more or longer than those of the non-GER group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that course of disease was protective factors for GER(OR=0.075,P<0.05),while vomiting,His angle,pH value<4 total reflux time ratio,the total reflux time ratio,the average number of reflux cycles,and the duration of reflux≥5 min times and the longest reflux duration were high risk factors for GER(OR=3.609,1.221,8.600,1.124,46.136,1.574,P<0.05).ROC curve results showed that the area under the curve(AUC)of His angle,pH value<4 total reflux time ratio,average number of reflux cycles,reflux duration≥5 min times,and longest reflux duration in predicting GER were 0.912,0.998,0.963,0.988,0.986,respectively.Conclusion Ultrasound measurement of esophageal His and 24 h esophageal dynamic pH monitoring are of high diagnostic value for GER,and can be used as an effective method for GER screening.

关 键 词：胃食管反流 超声 食管PH值 胃贲门角 诊断 动态监测 

分 类 号：R614[医药卫生—麻醉学] R445[医药卫生—外科学]