摘要
目的 了解小儿食管裂孔疝 (HH)时的酸反流情况及不同类型疝的酸反流特点。方法对 35例经钡餐造影确诊的HH患儿作 2 4h食管下端pH值监测 (DigitrapperMKⅢ型pH监测仪 ) ,其中滑动型 18例、食管旁型 8例、混合型 9例 ,16例健康儿作为对照组。结果 HH患儿各项反流指标明显大于对照组 ,差异有显著性 (P <0 0 1)。以Boix Ochoa综合评分为标准 ,35例HH患儿中 33例为病理性胃酸反流 ,占 94% (33 35 ) ;另 2例为生理性反流 ,其中 1例为食管旁型 ,1例为混合型。HH患儿卧位时除了食管pH值 <4的次数外 ,反流大于 5min的次数、最长反流时间、平均反流周期、总pH值 <4的时间百分比均大于立位时 ,差异有显著性 (P <0 0 1)。食管旁型的各项反流指标虽小于滑动型和混合型 ,但除了最长反流时间的差异有显著性 (P <0 0 5 )外 ,其余指标间的差异无显著性(P均 >0 0 5 )。结论 小儿HH大多伴有病理性胃食管反流 ,卧位时较为严重 ;其酸反流程度和临床症状与疝的类型关系不大 ,临床上应及时采取有效的抗反流治疗。
Objective To investigate the acid reflux in children with hiatal hernia (HH) and the characteristic of reflux among different types of HH. Methods Ambulatory 24 h lower esophageal pH monitoring was studied in 35 patients with HH confirmed by barium swallow, of whom 18 cases had sliding hernia, 8 had paraoesophageal hernia, 9 had mixed hernia, and 16 healthy infants formed the control groups. Results All parameters in HH patients were significantly higher than those in controls ( P< 0 01). Thirty three of 35 patients (accounting for 94%) had pathological acid reflux according to Boix Ochoa criterion, while the other 2 cases were considered to have physiological reflux, diagnosed as paraoesophageal hernia and mixed hernia, respectively. In HH patients, the number of reflux episodes lasting for 5 min, the duration of the longest episode, mean duration of reflux episodes and the percentage of time of pH<4 for total periods were significantly higher at lying than at standing position ( P< 0 05). No significant differences in all parameters except for the duration of the longest episode were found in the patients among three kinds of hernia. Conclusions These results showed that pathological acid reflux almost always existed in children with HH, especially at lying position. The association between the severe degree of acid reflux and the type of HH was not obvious. The study revealed that it is important to treat the HH patients with antireflux therapy early and effectively regardless its types.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2000年第1期26-28,共3页
Chinese Journal of Pediatrics
关键词
食管破裂
胃食管反流
食管裂孔疝
儿童
Hernia, hiatal
Hydrogen ion concentration
Gastroesophageal reflux
