【摘要】：目的探討Dx-pH監(jiān)測在咽喉反流(LPR)診斷中的應用價值,及其與質(zhì)子泵抑制劑(PPI)診斷性試驗結(jié)果的一致性,為兒童咽喉反流的診斷提供參考。方法選取2016年1月至2016年12月于深圳市兒童醫(yī)院耳鼻喉科就診的患兒。予反流癥狀指數(shù)評分量表(RSI)和反流體征評分量表(RFS)評分,將RSI13分和/或RFS7分的患兒納入研究,排除不符合標準的病例后共59例入選。依據(jù)年齡分為學齡前組和學齡組。所有患兒行咽喉pH檢測,予飲食管理+抗反流治療,每例患兒至少隨訪3個月,觀察患兒相應癥狀改善情況。期間失訪6例,追蹤到53例。結(jié)果53例符合研究標準患兒,其中男性39例,女性14例。學齡前組29例,學齡組24例。入選患兒多有合并癥,以合并鼻竇炎、咽炎、腺樣體肥大、喉炎及中耳炎常見。是否有合并疾病,對LPR的治療效果無影響。(1),學齡前組和學齡組治療前RFS評分,組間無統(tǒng)計學差異(P0.05),不同體征出現(xiàn)的頻率差異無統(tǒng)計學意義,RSI評分差異無統(tǒng)計學意義(P0.05)。(2)以Ryan指數(shù)為診斷標準得出其中15例患者可確診為LPR(28.3%)。pH事件≥3次有41例(77.4%),另有2例(3.8%)提示堿反流。(3)所有患者服用質(zhì)子泵抑制劑(PPI)4周后,18例(34.0%)顯效,24例(45.3%)好轉(zhuǎn),11例(20.8)無明顯改善,整體有效率為79.3%。(4)PPI診斷性試驗與Ryan指數(shù)結(jié)果一致性較差,和pH事件≥3次結(jié)果一致性中等。結(jié)論(1)Dx-pH監(jiān)測系統(tǒng)能準確監(jiān)測到反流事件,客觀證實LPR的存在。(2)兒童LPR多合并其他疾病共同存在,在鼻竇炎、中耳炎反復發(fā)作治療效果不佳時應考慮是否合并LPR。(3)兒童LPR多數(shù)體征表現(xiàn)較成人輕,飲食調(diào)整加規(guī)范抗反流治療,多數(shù)可取得較好的治療效果。(4)當依據(jù)患者癥狀和喉鏡下體征疑診LRP,而以Ryan指數(shù)為判定標準的24小時Dx-pH監(jiān)測為陰性時,參考pH事件≥3次的反流數(shù)據(jù)可有助于對患者病情的綜合判斷。
[Abstract]:Objective to explore the value of Dx-pH monitoring in the diagnosis of laryngeal reflux (LPR) and its consistency with the diagnostic results of proton pump inhibitor (PPI) in order to provide a reference for the diagnosis of laryngeal reflux in children. Methods Children from January 2016 to December 2016 were selected from otolaryngology department of Shenzhen Children's Hospital. Reflux symptom index scale (RSI) and reflux sign scale (RFS) were given to children with RSI13 and / or RFS7 scores. 59 cases were included in the study after substandard cases were excluded. According to the age, it was divided into preschool group and school age group. All the children were examined with pharynx and throat pH and treated with diet management anti-reflux therapy. Each patient was followed up for at least 3 months to observe the improvement of the corresponding symptoms. 6 cases were lost during the visit, 53 cases were followed up. Results 53 cases, 39 males and 14 females, met the criteria of the study. 29 cases in preschool group and 24 cases in school age group. Most of the patients were complicated with sinusitis, pharyngitis, adenoid hypertrophy, laryngitis and otitis media. There was no effect on the therapeutic effect of LPR. (1) the pre-school group and preschool group had pre-treatment RFS score. There was no statistical difference between the two groups (P0.05), and there was no significant difference in frequency of different signs (P0.05). (2). According to Ryan index, 15 patients were diagnosed as LPR (28.3%). PH events 鈮，

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