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目的 :抗反流治疗能有效地缓解胃食管反流 (GER)合并的阻塞性睡眠呼吸暂停 (OSA)。本研究旨在探讨抗反流治疗缓解OSA的机制。方法 :18例有反流症状和睡眠打鼾的患者接受了昼夜食管 pH和压力监测并与多导睡眠图 (PSG)同步监测 ;对同时有GER和OSA的 7名患者予以西沙必利和奥美拉唑抗反流治疗 1周后重复以上检查。结果 :(1)发生GER期间出现呼吸暂停 /低通气是未发生GER期间出现呼吸暂停 /低通气总次数的 4.5倍 (2 2 2 .7± 12 .6比49.5± 11.8) ;(2 )GER引起OSA前 30秒内其平均最低远端食管体部基础压为 -16.2± 8.6mmHg ,GER引起OSA后30秒内为 -19.6± 9.1mmHg ,两者均明显低于远端食管平均基础压 (-11.2± 7.6mmHg ,P <0 .0 0 5 ) ;而食管平均基础压从抗反流治疗前的 -11.2± 7.6mmHg上升到抗反流治疗后的 -6.2± 3.6mmHg(P <0 .0 5 )。 (3)抗反流治疗后食管有效加部份有效蠕动收缩百分比明显增加 ,(从 2 4.0± 5 .4%上升到 5 8.6± 6.2 % ,P <0 .0 5 )。 (4 )抗反流治疗后 ,呼吸暂停 /低通气指数从 38.9± 17.6次 /h下降到 11.2± 12 .3次 /h(P <0 .0 0 2 )。结论 :(1)抗反流治疗可能通过提高食管体部基础压 ,使胸内负压下降 ,有利于防止气道塌陷。 (2 )抗反流治疗通过改善食管体部有效蠕动收缩 ,加快了
Objective: Anti-reflux therapy can effectively relieve gastroesophageal reflux (GER) combined obstructive sleep apnea (OSA). The aim of this study was to investigate the mechanism of anti-reflux therapy in relieving OSA. METHODS: Eighteen patients with reflux symptoms and sleep snoring were monitored for diurnal esophageal pH and pressure monitoring and synchronized with polysomnography (PSG). Seven patients with both GER and OSA were administered cisapride and omeprazole Azole anti-reflux treatment after 1 week to repeat the above examination. RESULTS: (1) Apnea / hypopnea during GER occurred 4.5 times (21.27 ± 12.6 vs. 49.5 ± 11.8) times of total number of apnea / hypopneas during GER; (2) GER The average minimum basal pressure of the distal esophageal body was -16.2 ± 8.6 mmHg in the first 30 seconds before OSA and -19.6 ± 9.1 mmHg in 30 seconds after GER, both of which were significantly lower than the average basal pressure of distal esophagus -11.2 ± 7.6mmHg, P <0.05). The mean esophageal pressure increased from -11.2 ± 7.6mmHg before anti-reflux treatment to -6.2 ± 3.6mmHg after anti-reflux treatment (P <0. 0 5). (3) Esophageal effective plus some effective peristalsis contractility increased significantly after anti-reflux therapy (from 4.04 ± 5.4% to 58.6 ± 6.2%, P <0.05). (4) After anti-reflux therapy, the apnea / hypopnea index decreased from 38.9 ± 17.6 times / h to 11.2 ± 12.3 times / h (P0.002). Conclusion: (1) Anti-reflux therapy may reduce the negative pressure in the thorax by increasing the basic pressure of the esophageal body, which is good for preventing airway collapse. (2) anti-reflux therapy by accelerating the effective esophageal motility contraction, accelerated