咽喉反流性疾病不同体位反流模式的研究  

Influence of body positions on laryngopharyngeal reflux disease

作　　者：孙喆喆 王刚[1,2] 王磊 李保卫[1] 韩浩伦 刘红丹[1] 张晓丽 吴玮[1,2] SUN Zhezhe;WANG Gang;WANG Lei;LI Baowei;HAN Haolun;LIU Hongdan;ZHANG Xiaoli;WU Wei(Dapartment of Otolaryngology,the Ninth Medical Centerof Chinses PLA General Hospital;State Environmental Protection Key Laboratory of Environmental Sense Organ Stress and Health,Beijing 100101,China)

机构地区：[1]中国人民解放军总医院第九医学中心耳鼻喉科 [2]国家环境保护环境感官应激与健康重点实验室,北京100101

出　　处：《山东大学耳鼻喉眼学报》2024年第6期91-95,102,共6页Journal of Otolaryngology and Ophthalmology of Shandong University

基　　金：战略支援部队特色医学中心学科助推计划资助项目(21XK0103)

摘　　要：目的 探讨咽喉反流性疾病的不同体位反流模式的特点。方法 回顾2016年5月至2023年5月间,在战略支援部队特色医学中心耳鼻咽喉头颈外科就诊的987例疑似咽喉反流性疾病(laryngophyngeal reflux disease, LPRD)患者的一般情况、Dx-pH监测数据及反流症状量表(reflux symptom index, RSI)、反流体征量表(reflux finding score, RFS)数据,根据立位和卧位Ryan指数将Ryan指数阳性患者分为单纯立位阳性、单纯卧位阳性及双阳性组,比较各组的RSI、RFS及各项反流参数。采用SPSS 24.0进行统计学分析。结果 987例研究对象中,Ryan指数阳性288例,其中单纯立位阳性176例(61.1%)、单纯卧位阳性47例(16.3%)、双阳性65例(22.6%)。各组间性别及年龄差异无统计学意义,各组RSI数值及阳性率差异无统计学意义(P=0.29,P=0.345),其中症状痰多或涕倒流立位组评分高于卧位组,差异有统计学意义(P=0.008)。各组RFS数值及分项数值差异无统计学意义,RFS阳性率双阳性组高于卧位组高于立位组,差异有统计学意义(P=0.009)。pH监测参数比较显示:双阳性组的反流时间百分比、反流次数、最长反流时间均显著高于其他两组,差异有统计学意义(P<0.001)。立位组在反流时间百分比和最长反流时间两项上显著小于卧位组(P<0.001),但反流总次数两组差异无统计学意义(P=0.357)。结论 LPRD患者中以立位反流模式为主,立位的反流事件的特点是含气反流为主且持续时间较短,其对气道黏膜的损伤作用弱于卧位反流,但引起的患者主观症状较重。Objective To explore the characteristics of different postural reflux patterns in laryngopharyngeal reflux disease.Methods In a retrospective study,we reviewed the clinical data of 987 patients with symptoms of LPRD from May 2016 to May 2023.According to the upright and supine Ryan index,patients with positive Ryan index were divided into upright-positive,supine-positive and double-positive groups,and the RSI,RFS and various reflux parameters of each group were compared.Statistical analy-sis was performed with SPSS 24.0.Results Among the 987 subjects,288 cases were positive for Ryan index,of which 176 cases(61.1%)were upright positive,47 cases(16.3%)were supine positive,and 65 cases(22.6%)were double positive.There was no statistically significant difference in gender and age among the groups,and there was no significant difference in RSI score and posi-tive rate among the groups(P=0.29,P=0.345).The scores for the excess throat mucus or postnasal drip were higher in upright-positive group than in the supine-positive group(P=0.008).There was no significant difference in RFS scores and sub-items among the groups,but the positive rate of RFS in the double-positive group was higher than that in the supine-positive and upright-positive groups(P=0.009).Comparison of pH monitoring parameters showed that the percentage of reflux time,the number of refluxes,and the longest reflux time were significantly higher in the double-positive group than in the other two groups(P<0.001).The percent-age of reflux time and the longest reflux time in the upright group were significantly shorter than those in the supine group(P<0.001),but there was no significant difference in the total number of refluxes between the two groups(P=0.357).Conclusion The upright reflux pattern is predominant in the LPRD patiens.Upright relux events are characterised by air-containing reflux and short duration.Upright reflux was less damaging to the mucosa,but could cause more serious subjective symptoms.

关 键 词：咽喉反流 胃食管反流 体位 PH监测 

分 类 号：R766.5[医药卫生—耳鼻咽喉科]