论文部分内容阅读
目的：观察胃食管反流病（ＧＥＲＤ）的食管继发蠕动异常及意义，探讨食管继发蠕动诱发试验用于ＧＥＲＤ辅助诊断的可行性及价值。方法：用气液压毛细管灌注系统连接自行设计的８腔导管对３５例正常人和４５例ＧＥＲＤ患者进行常规食管测压及食管继发蠕动诱发试验。结果：自行设计的８腔测压导管兼备作常规测压和同时进行大丸水剂注射诱发食管继发蠕动的功能，８０例均能顺利完成检查。ＧＥＲＤ组常规测压各项指标的总异常率为４４％（２０／４５），ＧＥＲＤ组继发蠕动诱出率中位数为０％，低于ＨＳ组的６０（Ｐ＜００５）。ＧＥＲＤ组４５例中３０例患者对５次大丸水剂注射均无反应（诱出率为０％，称无反应者），其中１５例为常规测压各项指标均为正常者。诱发试验使ＧＥＲＤ组食管动力学异常检出率提高到７８％（３５／４５）。不管是原发或继发蠕动，ＧＥＲＤ组的波幅及蠕动传导速度均比ＨＳ组低（Ｐ均＜００５）。在ＧＥＲＤ组，２４小时的ｐＨ值监测发现最长酸反流持续时间＜２０分钟的２０例中无反应者只有６例，而最长酸反流持续时间≥２０秒的２５例中无反应者达２４例（Ｐ＜００５）。说明食管继发蠕动功能下降，使反流物得不到及时消除，可增加粘膜酸暴露的时间而致ＧＥＲＤ发生。结?
Objective: To observe the abnormal esophageal peristalsis of gastroesophageal reflux disease (GERD) and its significance, and to explore the feasibility and value of secondary esophageal peristalsis test in the diagnosis of GERD. Methods: Conventional esophageal manometry and esophageal peristalsis induction test were performed in 35 normal subjects and 45 GERD patients by using a self-designed 8-chamber catheter with a gas-hydraulic capillary perfusion system. Results: The self-designed 8-chamber manometry catheter both routine pressure measurement and simultaneous injection of Daimaru drug induced esophageal peristalsis function, 80 cases were able to successfully complete the examination. In the GERD group, the total abnormal rate of each index of routine manometry was 44% (20/45). The median rate of secondary peristalsis in GERD group was 0%, which was lower than that in HS group (P <005). In the 45 cases of GERD group, 30 patients did not respond to 5 times Daimaru injection (0% of the patients were elicited), and 15 of them were normal by normal manometry. Induction test increased the detection rate of esophageal motility abnormalities in GERD group to 78% (35/45). No matter primary or secondary peristalsis, the amplitude and peristaltic conduction velocity of GERD group were lower than those of HS group (all P <0.05). In the 24-hour pH monitoring in the GERD group, only 6 of the 20 patients with the longest duration of acid reflux <20 minutes had no response and none of 25 patients with the longest duration of acid reflux> 20 seconds Up to 24 cases (P <005). Description of secondary esophageal peristalsis decreased, so that the reflux can not be eliminated in time, can increase the mucosal acid exposure time caused GERD. Knot?