本文關(guān)鍵詞： 慢性咳嗽 胃食管反流病 食管高分辨測(cè)壓 動(dòng)態(tài)24h-pH-阻抗監(jiān)測(cè)　出處：《首都醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：胃食管反流病(GERD)是一種常見的消化道功能性疾病,隨著社會(huì)發(fā)展,本病的發(fā)病率逐年上升。本病的臨床表現(xiàn)可分為典型癥狀、非典型癥狀;典型癥狀主要包括燒心、反流;非典型癥狀主要包括咳嗽、咽下困難、癔球癥等;咳嗽是胃食管反流病患者臨床上較為常見的非典型癥狀,其嚴(yán)重影響著患者的生活質(zhì)量。本臨床研究對(duì)同時(shí)行食管高分率測(cè)壓(HRiM)及動(dòng)態(tài)24h-pH-阻抗監(jiān)測(cè)的以慢性咳嗽為主要癥狀的GERD患者的動(dòng)力學(xué)及反流參數(shù)進(jìn)行多因素分析,旨在進(jìn)一步明確以咳嗽為主要癥狀胃食管反流病患者的動(dòng)力學(xué)及反流特征。方法:(1)選取2010.5-2015.4就診于首都醫(yī)科大學(xué)附屬北京朝陽(yáng)醫(yī)院消化科同時(shí)行食管高分辨率測(cè)壓(HRiM)及動(dòng)態(tài)24h-pH-阻抗監(jiān)測(cè)的胃食管反流病(GERD)患者254例,健康對(duì)照組62例:根據(jù)臨床癥狀將GERD患者分為以慢性咳嗽為主要癥狀GERD組(簡(jiǎn)稱:咳嗽GERD組)及非咳嗽GERD組(反酸、燒心為主要癥狀的典型癥狀組)(2)回顧性分析入組人員性別、年齡、臨床癥狀、食管高分辨率測(cè)壓及動(dòng)態(tài)24h-pH-阻抗監(jiān)測(cè)各項(xiàng)數(shù)據(jù);(3)統(tǒng)計(jì)學(xué)分析:采用SPSS20.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行分析,p0.05認(rèn)為有統(tǒng)計(jì)學(xué)意義。結(jié)果:咳嗽GERD組患者年齡范圍在24-84(53.15±14.91)歲之間,經(jīng)分析咳嗽GERD組患者發(fā)病呈雙峰,分別為30-34歲和55-64歲兩個(gè)年齡段;咳嗽GERD組與對(duì)照組相比在液體清除率、粘性清除率、遠(yuǎn)端食管蠕動(dòng)波幅、IRP、UES殘余壓等總共45個(gè)指標(biāo)存在統(tǒng)計(jì)學(xué)差異,p0.05;咳嗽GERD組IRP(5.94±5.70)mmHg較非咳嗽GERD組(7.22±6.84)mmHg明顯降低,p0.05;咳嗽GERD組粘性清除率29.92%(20.0%,50.0%)較非咳嗽GERD組39.05%(10.0%,70.0%)明顯下降,p0.05;咳嗽GERD組近端臥位非酸返流次數(shù)2.14(0,3.0)較非咳嗽GERD組1.16(0,2.0)明顯增加,p0.05;咳嗽GERD組立位非酸食團(tuán)暴露時(shí)間1.59(0.5,2)、臥位非酸食團(tuán)暴露時(shí)間0.41(0,0.5)較非咳嗽GERD組1.22(0,2.0)、0.18(0,0)均明顯延長(zhǎng),p0.05;咳嗽GERD組、非咳嗽GERD組及對(duì)照組近端立位酸返流次數(shù)分別為9.02(3.0,15.0)、11.67(4.0,16.0)、5.74(2.0,9.0),咳嗽GERD組較非咳嗽GERD組明顯減少,與對(duì)照組相比明顯增多,均存在統(tǒng)計(jì)學(xué)差異(p0.05);Logistic回歸分析表明,與典型癥狀胃食管反流病患者相比,食管下括約肌壓力明顯降低、粘性食團(tuán)清除障礙、臥位非酸食團(tuán)暴露時(shí)間增加、臥位非酸返流次數(shù)增加是慢性咳嗽為主要癥狀胃食管反流病患者的主要食管動(dòng)力學(xué)異常及反流特征。結(jié)論:與典型癥狀胃食管反流病患者相比,食管下括約肌壓力明顯降低、粘性食團(tuán)清除障礙、臥位非酸食團(tuán)暴露時(shí)間增加、臥位非酸返流次數(shù)增加是慢性咳嗽為主要癥狀胃食管反流病患者的主要食管動(dòng)力學(xué)異常及反流特征。
[Abstract]:Gastroesophageal reflux disease (GERD) is a common functional disease of digestive tract. With the development of society, the incidence of GERD increases year by year. The clinical manifestations of GERD can be divided into typical symptoms and atypical symptoms. Typical symptoms include heartburn, reflux; Atypical symptoms include cough, dysphagia, globus sensation and so on. Cough is a common atypical symptom in patients with gastroesophageal reflux disease. It seriously affects the quality of life of patients. In this clinical study, HRiM was performed at the same time with high score of esophagus manometry. The dynamic and reflux parameters of patients with GERD with chronic cough as the main symptom were analyzed by multivariate analysis. To further clarify the dynamics and reflux characteristics of patients with gastroesophageal reflux disease (GERD) with cough as the main symptom. Methods: 1). HRiM was selected from Beijing Chaoyang Hospital affiliated to Capital Medical University from May to April, 2010.5-2015.4 to perform esophageal high resolution manometry (HRiM) at the same time. And 254 patients with gastroesophageal reflux disease (GERD) with dynamic 24 h-pH impedance monitoring. 62 healthy control group: according to clinical symptoms, GERD patients were divided into chronic cough as the main symptom of GERD group (abbreviated as cough GERD group) and non-cough GERD group (regurgitated acid). The data of sex, age, clinical symptoms, esophageal high resolution manometry and dynamic 24h-pH impedance monitoring were analyzed retrospectively. Statistical analysis: SPSS20.0 software was used to analyze the data. Results: the age range of patients with cough GERD was 24-84 鹵53.15 鹵14.91 years old. There were two peaks in cough GERD group, 30-34 years old and 55-64 years old. Compared with the control group, 45 indexes of cough GERD group, such as fluid clearance rate, viscous clearance rate, distal esophageal peristalsis amplitude and IRPU es residual pressure, were significantly different (P 0.05). IRP(5.94 鹵5.70 mm Hg in cough GERD group was significantly lower than that in non-cough GERD group (7.22 鹵6.84 mm Hg). The viscosity clearance rate of cough GERD group (29.92%) was significantly lower than that of non-cough GERD group (P 0.05). The frequency of non-acid reflux in the proximal recumbent position of cough GERD group was 2.14 0 ~ 3.0), which was significantly higher than that in non-cough GERD group (1. 160 ~ 0 ~ 2. 0) (P < 0. 05). The exposure time of standing non-acid food group and lying position non-acid food group in cough GERD group was 1.59 and 0.5,0.41 and 0.50 respectively) compared with that in non-cough GERD group. (2) 0. 18 (0. 0)) (P < 0. 05, P < 0. 05); The times of acid reflux at the proximal end of the cough GERD group, the non-cough GERD group and the control group were 9.02 ~ 3.0 ~ 15.0 ~ 11.67 ~ 4.0 ~ 16.0). 5.74A 2.0 ~ 9.0%, cough GERD group was significantly lower than non-cough GERD group, and significantly increased compared with the control group, there was statistical difference between the two groups (P 0.05). Logistic regression analysis showed that the pressure of lower esophageal sphincter was significantly lower than that of patients with typical symptoms of gastroesophageal reflux disease (GERD). The increase of non-acid reflux in supine position is the main characteristic of abnormal esophageal dynamics and reflux in patients with chronic cough as the main symptom of gastroesophageal reflux disease. Conclusion: compared with the patients with typical symptom gastroesophageal reflux disease. The pressure of lower esophageal sphincter was decreased obviously, the sticky food mass was removed and the exposure time of non-acid food mass in lying position was increased. The increase of non-acid reflux in supine position was the main characteristic of abnormal esophageal dynamics and reflux in patients with chronic cough as the main symptom of gastroesophageal reflux disease.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R571

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