摘要
目的探讨胃食管反流病(GERD)患者膈脚屏障功能及食管体部的清除功能在胃食管反流中的作用。方法GERD组和健康(HS)对照组同步进行餐前1h和餐后2h食管pH值和食管动力监测。结果(1)pH监测结果:GERD组8例,餐后pH<4的百分比中位数为11.2%;而HS组8例,餐后pH<4的百分比中位数为0.45%,两组相比差异有显著性(P<0.05)。(2)GERD组和HS组餐后下食管括约肌压力(LESP)均较餐前下降(P<0.001);GERD组及HS组餐前或餐后LESP两组比较差异无显著性(P>0.05)。(3)GERD组餐前及餐后与吞咽相关的下食管括约肌松弛后蠕动收缩波幅(Post-LESRA)明显低于HS组,两组比较差异有显著性(P<0.001)。(4)与HS组比较GERD组餐前及餐后静息膈脚张力(Dia-A0)均明显降低,差异有显著性(P<0.05)。(5)餐前及餐后深吸气时膈脚张力(Dia-AM),在GERD和HS两组间比较,差异无显著性(P>0.05),两组深吸气时膈脚张力可使胃食管交界处(EGJ)压力升高3～4倍。(5)GERD组餐前及餐后食管远端蠕动收缩波幅明显低于HS组,两组比较差异有显著性(P<0.001)。结论(1)静息膈脚张力、食管远端蠕动清除功能及与吞咽相关的下食管括约肌(LES)松弛后蠕动清除能力在GERD发病中起重要的作用。(2)深吸气时GERD组和HS组膈脚张力均可使EGJ区域压力增高数倍。
Objective Aim of this study was to investigate functions of lower esophageal sphincter(LES)barrier and esophageal clearance in fasting and postprandial stages in gastroesophageal reflux disease(GERD).Methods Eight patients with confirmed GERD and8healthy subjects(HS)were observed in the study.The esophageal pH and manometry were recorded simultaneously for1h during fasting and2h after a meal(1675kJ)using pneumohydrolic capillary perfusion system.Results(1)The esophageal pH monitoring showed that median of percentage of pH<4at postprandial in HS and patients with GERD was0.45%and11.2%,respectively(P<0.05).(2)Pressure of lower esophageal sphincter(LESP)significantly decreased after a test meal in GERD(P<0.001)and in HS (P<0.001).(3)The amplitude of post-LES relaxation related to swallow (post-LESRA)in GERD was much lower than in HS either during fasting or postprandial stage(P<0.05).(4)The tension of crural diaphragm at resting(Dia-A 0 )in GERD was lower than in HS during fasting and postprandial stage(P<0.05).(5)The tension of crural diaphragm at deep inspiration (dia-A M )in GERD and HS incr-eased3or4times at pressure at gastroesophageal junction(GEJ).(6)The peristaltic amplitude of the distal esophagus in GERD were much lower than that in HS in both pre-and postprandial periods.Conclusions (1)Impaired clearance of Post-LESRA and esophageal body,function of diaphragmatic crural play an important role in development of GERD.(2)The tension of crural diaphragm at deep inspiration can increase the pressure at GEJ.
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2002年第3期288-293,共6页
Acta Academiae Medicinae Sinicae
