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目的通过比较食管扩张刺激-脑诱发电位(OD-CEP)的改变,探讨非糜烂性胃食管反流病(NERD)患者食管内脏高敏感性的发生机制,旨在进一步获得NERD患者食管-中枢内脏感觉传导通路失调的客观依据。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的导管给食管以时相性扩张刺激;利用食管气囊扩张术检测受试者食管最大耐受痛阈,用75%最大疼痛耐受容积作为诱发刺激的强度(刺激频率为12次/分,连续64次);采用OD-CEP系列技术记录并分析NERD患者和正常人CEP的变化。结果食管气囊扩张刺激能诱发出可识别、可重复的、多峰的CEP波形,以NP型为主。与正常对照者比较,NERD患者CEP波形变异性大,其N1、P1、N2波潜伏期明显缩短(P值分别为0·016,0·003,0·031),且NERD患者CEP的P1-N2峰间波幅明显增加(P=0·03)。结论NERD患者经食管时相性扩张后产生的特征性CEP改变证实其食管内脏高敏感性及食管-中枢内脏感觉传导通路的失调。
Objective To investigate the mechanism of esophageal visceral hypersensitivity in patients with non-erosive gastroesophageal reflux disease (NERD) by comparing the changes of esophageal dilatation-evoked potentials (OD-CEPs) with a view to further obtaining esophageal-central viscera Sensory conduction pathway disorders based on the objective. Methods Ten healthy volunteers and twenty-one NERD patients were enrolled in the experiment. Synectics visceral stimulator / electropneumatic pump and catheter with low-compliance balloon were used to stimulate the esophagus with phasic dilation. The subjects were examined by esophageal balloon dilatation Esophageal maximum tolerated pain threshold, 75% of the maximum pain tolerance volume as the stimulus intensity (stimulation frequency of 12 beats / min, continuous 64 times); using OD-CEP series of techniques to record and analyze NERD patients and normal CEP Variety. Results Expansion stimulation of esophageal balloon could induce a recognizable, repeatable and multimodal CEP waveform, which was mainly NP type. Compared with the normal controls, NEPD patients had large variability of CEP waveforms and significantly decreased latency of N1, P1 and N2 waves (P = 0.016,0.003 and -0.031, respectively), and CEP P1-N2 The peak amplitude increased significantly (P = 0.03). Conclusions The characteristic CEP changes after pharyngeal pharyngeal dilatation in patients with NERD confirmed the high sensitivity of visceral viscera and the imbalance of esophageal - central visceral sensory transduction pathways.