本文關(guān)鍵詞： Stretta射頻治療 胃食管反流病 哮喘　出處：《遼寧醫(yī)學(xué)院》2012年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的 通過(guò)分析比較單純胃食管反流病（GERD）、反流性哮喘和過(guò)敏性哮喘（AS）合并胃食管反流病三組病人的Stretta射頻治療效果，，探討反流性哮喘的射頻治療的作用機(jī)制。 方法 選取我院2010年8月至2011年05月的入住我院胃食管反流病中心的患者為實(shí)驗(yàn)初選對(duì)象，收集患者的臨床資料，包括年齡、性別等一般項(xiàng)目，進(jìn)行癥狀評(píng)分、胃鏡、阻抗、食管測(cè)壓等檢查，選出確診為GERD患者60例，且分為單純GERD組即消化道癥狀組20例、反流性哮喘組20例、AS合并GERD組20例。分析比較三組患者的痰液嗜酸性粒細(xì)胞及中性粒細(xì)胞比例、外周血嗜酸性粒細(xì)胞百分比、肺功能最大呼氣流量（PEF）；三組患者均行Stretta射頻治療，且于治療后半年復(fù)查胃鏡、阻抗、食管測(cè)壓，對(duì)各復(fù)查的客觀(guān)項(xiàng)目行統(tǒng)計(jì)分析。 結(jié)果 1.誘導(dǎo)痰細(xì)胞學(xué)檢查中，反流性哮喘組和AS合并GERD組中性粒細(xì)胞、嗜酸性細(xì)胞百分率較單純GERD組明顯增高。反流性哮喘組與AS合并GERD組比較，中性粒細(xì)胞百分率明顯增高，嗜酸性細(xì)胞百分率減低，差異均有統(tǒng)計(jì)學(xué)意義。 2．外周血檢查中，AS合并GERD組嗜酸性粒細(xì)胞百分率較單純GERD組及反流性哮喘組明顯增高，差異有統(tǒng)計(jì)學(xué)意義。 3．Stretta射頻治療后半年隨訪(fǎng)，反流性哮喘患者癥狀評(píng)分的下降程度和緩解的總有效率顯著優(yōu)于其它兩組（P0.05）。復(fù)查項(xiàng)目的比較中，三組的阻抗檢查Z2通道（即LES上15cm）反流占總反流次數(shù)百分比、DeMeester積分、pH≤4所占總檢測(cè)時(shí)間百分比均明顯減少（P0.05），三組下食管括約肌壓力有輕度升高、食管炎發(fā)生率不同程度降低，但差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。反流性哮喘組及AS合并GERD組PEF均明顯改善，且反流性哮喘組改善程度顯著優(yōu)于后組（P0.05）。 結(jié)論 1．反流性哮喘的氣道炎癥是以中性粒細(xì)胞為主的炎性浸潤(rùn)，明顯區(qū)別于以嗜酸性細(xì)胞浸潤(rùn)為主的過(guò)敏性哮喘；可以將誘導(dǎo)痰細(xì)胞學(xué)檢查中的細(xì)胞學(xué)分類(lèi)及外周血的嗜酸性粒細(xì)胞的百分率用于反流性哮喘和過(guò)敏性哮喘的鑒別。 2．胃鏡下Stretta射頻治療通過(guò)降低反流的高度、阻斷神經(jīng)機(jī)制和減少一過(guò)性下食管括約肌松弛等機(jī)制有效控制胃食管反流，是治療反流性哮喘的一種安全、有效的方法。
[Abstract]:Purpose. To explore the mechanism of radiofrequency (RF) therapy of reflux asthma (GERD), reflux asthma and allergic asthma (ASA) combined with gastroesophageal reflux disease (GERD), the effects of Stretta radiofrequency (RF) on gastroesophageal reflux disease (GERD) were analyzed and compared. Method. Patients admitted to gastroesophageal reflux disease center from August 2010 to May 2011 in our hospital were selected as primary subjects. Clinical data, including age, sex and other general items, were collected for symptom score, gastroscopy, impedance, and so on. By esophageal manometry and other examinations, 60 patients with GERD were selected and divided into GERD group (n = 20) and digestive tract symptom group (n = 20). The ratio of eosinophils and neutrophils in sputum, the percentage of eosinophils in peripheral blood and the maximal expiratory flow rate of lung function were analyzed and compared in 20 patients with reflux asthma combined with GERD. Gastroscopy, impedance and esophageal manometry were performed half a year after treatment. Results. 1. In induced sputum cytology, the percentage of eosinophil in reflux asthma group and as combined with GERD group was significantly higher than that in simple GERD group, and the percentage of neutrophil in reflux asthma group was significantly higher than that in as combined with GERD group. The percentage of eosinophilic cells decreased, and the difference was statistically significant. 2. The percentage of eosinophil in as combined with GERD group was significantly higher than that in GERD group and reflux asthma group. 3. After half a year follow-up of Stretta radiofrequency therapy, the degree of symptom score decline and the total effective rate of remission in patients with reflux asthma were significantly higher than those in the other two groups (P 0.05). The percentage of reflux in the total reflux times of the three groups (i.e. 15 cm above LES) and the percentage of the total detection time of de Meester integral pH 鈮

本文編號(hào)：1510525