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目的研究酸灌注刺激对非糜烂性胃食管反流病(NERD)患者食管内脏敏感性的影响,探讨内脏感觉异常在NERD发病机制中的作用。方法10例正常健康自愿者和21例NERD患者参与试验;采用Synectics内脏刺激器/电子气压泵和带有低顺应性气囊及多个灌注式压力通道的导管给食管以快速时相性气球扩张性刺激和进行食管酸灌注;利用食道气囊扩张术检测受试者对食管气囊扩张的反应。结果酸灌注前NERD患者食管气囊扩张诱发的初始感觉阈值和最大耐受疼痛阈值均低于健康对照组(P<0.01)。酸灌注后NERD患者初始感觉阈值和最大耐受痛阈均比相应基线值降低(P=0.015);酸灌注后健康对照组初始感觉阈值比相应基线值明显降低(P<0.05),但最大耐受痛阈值无显著变化。NERD患者酸灌注的最大耐受痛阈为(9.70±3.06)ml,显著低于健康志愿者的(22.10±4.91)ml(P<0.01)。食管生理盐水灌注对NERD组和健康对照组的各项内脏敏感性指标均无明显的影响。结论酸灌注致敏食管壁化学感受器可明显增加NERD患者对食道机械刺激的反应,提示酸敏感的化学感受器和压力敏感的机械感受器之间可协同作用共同促进食管内脏高敏感性的形成。
Objective To investigate the effect of acid perfusion on esophageal visceral sensitivity in patients with non-erosive gastroesophageal reflux disease (NERD) and to explore the role of visceral abnormalities in the pathogenesis of NERD. Methods Ten healthy volunteers and twenty-one NERD patients were enrolled in the study. Sympathetic visceral stimulator / electropneumatic pump and catheter with low compliance balloon and multiple perfusion pressure channels And esophageal acid perfusion; the use of esophageal balloon dilatation test subjects to respond to expansion of the esophageal balloon. Results The initial sensory threshold and maximum tolerated pain threshold induced by esophageal balloon dilatation before acid perfusion were lower than those in healthy controls (P <0.01). The initial sensory threshold and the maximum tolerated pain threshold of NERD patients after acid perfusion were lower than the corresponding baseline values (P = 0.015). The initial sensory threshold of the healthy control group after acid perfusion was significantly lower than the corresponding baseline values (P <0.05) Pain threshold no significant change. The maximum tolerated pain threshold for acid perfusion in NERD patients was (9.70 ± 3.06) ml, significantly lower than that in healthy volunteers (22.10 ± 4.91) ml (P <0.01). Esophageal saline infusion had no significant effect on visceral sensitivity of NERD group and healthy control group. Conclusion Acid-sensitized esophageal wall chemotherapeutic agents can significantly increase the response to esophageal mechanical stimulation in patients with NERD, suggesting that the synergistic effect between acid-sensitive chemosensors and pressure-sensitive mechanoreceptors can promote the formation of visceral hypersensitivity.