本文選題：24小時(shí)食管PH-阻抗監(jiān)測(cè) + 高分辨率食管測(cè)壓�。� 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:應(yīng)用24小時(shí)食管PH-阻抗監(jiān)測(cè)、高分辨率食管測(cè)壓、焦慮抑郁評(píng)分以及反流性疾病問(wèn)卷評(píng)分檢查,對(duì)難治性胃食管反流病(Refractory gastroesophageal reflux disease,RGERD)患者進(jìn)行了分析,探討RGERD的發(fā)病機(jī)制。方法:隨機(jī)選擇84例難治性胃食管反流病患者,選取92例同期經(jīng)PPI治療后癥狀消失的胃食管反流病患者(Gastroesophageal reflux disease,GERD)作為對(duì)照組,所有研究對(duì)象均進(jìn)行24小時(shí)食管PH-阻抗監(jiān)測(cè)、高分辨率食管測(cè)壓、并完成焦慮抑郁評(píng)分以及反流性疾病問(wèn)卷評(píng)分,記錄各組患者酸反流、非酸反流、弱酸反流、長(zhǎng)酸反流、近端反流的次數(shù),食管上、下括約肌及食管體部相關(guān)參數(shù),焦慮抑郁評(píng)分以及反流性疾病問(wèn)卷評(píng)分,比較各組之間的參數(shù)差別。結(jié)果:1.RGERD組較GERD對(duì)照組弱酸反流次數(shù)增多,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組長(zhǎng)酸反流次數(shù)增多,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組近端反流次數(shù)增多,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組酸反流次數(shù)無(wú)明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組非酸反流次數(shù)無(wú)明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.RGERD組較GERD對(duì)照組氣體反流次數(shù)增多,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組液氣混合反流次數(shù)增多,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組液體反流次數(shù)無(wú)明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.RGERD組較GERD對(duì)照組食管下括約肌長(zhǎng)度(LESL)更短,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組食管下括約肌壓力(LESP)更低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.RGERD組較GERD對(duì)照組食管上括約肌壓力(UESP)更低,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組食管上括約肌長(zhǎng)度(UESL)無(wú)明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5.RGERD組較GERD對(duì)照組一過(guò)性食管下括約肌每小時(shí)松弛次數(shù)、每次松弛時(shí)間無(wú)明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。6.RGERD組較GERD對(duì)照組食管體部參數(shù)DCI無(wú)明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組PB、DL無(wú)明顯差異,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。7.RGERD組較GERD對(duì)照組存在焦慮、抑郁的發(fā)病率均顯著高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組焦慮自評(píng)量表(SAS)、抑郁自評(píng)量表(SDS)評(píng)分均顯著高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);RGERD組較GERD對(duì)照組反流性疾病問(wèn)卷(RDQ)評(píng)分均顯著高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、RGERD組較GERD對(duì)照組弱酸反流次數(shù)增多、長(zhǎng)酸反流次數(shù)增多、近端反流次數(shù)增多,均可導(dǎo)致PPI抑制不完全。2、RGERD組較GERD對(duì)照組氣體反流次數(shù)和液氣混合反流次數(shù)增多,加重反流癥狀感知。3、RGERD組的食管下括約肌長(zhǎng)度(LESL)較GERD對(duì)照組更短,且食管下括約肌壓力(LESP)更低,食管上括約肌壓力(UESP)更低,表明在RGERD的發(fā)病機(jī)制中,食管下括約肌的長(zhǎng)度、壓力以及食管上括約肌壓力起到了重要作用。4、RGERD組較GERD對(duì)照組存在焦慮、抑郁傾向,提示精神心理因素參與RGERD的發(fā)病。
[Abstract]:Objective: 24 hours esophageal PH- impedance monitoring, high resolution esophageal manometry, anxiety and depression score and reflux disease questionnaire were used to analyze the patients with refractory gastroesophageal reflux disease (Refractory gastroesophageal reflux disease, RGERD) and to explore the pathogenesis of RGERD. Methods: 84 cases of refractory Gastroesophagus were selected randomly. Patients with reflux disease were selected 92 cases of Gastroesophageal reflux disease (GERD) which disappeared after PPI treatment as control group. All the subjects carried out 24 hours esophageal PH- impedance monitoring, high resolution esophageal manometry, and completed anxiety depression score and reflux disease questionnaire score, and recorded each group of patients. Acid reflux, non acid reflux, weak acid reflux, long acid reflux, the number of near end reflux, the related parameters of the esophagus, the lower sphincter and the esophagus, the anxiety and depression score and the reflux disease questionnaire score were compared. Results: the number of reverse reflux in group 1.RGERD was more than that of GERD group, and the difference was statistically significant (P0.05) The number of acid reflux in group RGERD was higher than that of GERD group (P0.05), and the number of reverse reflux in group RGERD was higher than that in GERD control group, the difference was statistically significant (P0.05), and there was no significant difference between the RGERD group and GERD control group, and the difference was not statistically significant (P0.05), and the number of non acid reflux in RGERD group was less obvious than that in GERD control group. There was no significant difference (P0.05) in group.2.RGERD compared with GERD control group, the number of gas reflux increased, the difference was statistically significant (P0.05), and the number of mixed reflux in RGERD group was more significant than that of GERD control group (P0.05), and there was no significant difference in the number of reflux in RGERD group compared with GERD (P0.0), and there was no significant difference (P0.0). 5) the lower esophageal sphincter length (LESL) in the.3.RGERD group was shorter than that in the GERD control group (P0.05), and the lower esophageal sphincter pressure (LESP) in the RGERD group was lower than that in the GERD control group, and the difference was statistically significant (P0.05) in the.4.RGERD group than in the GERD control group (UESP), and the difference was statistically significant (P0.05). There was no significant difference in the upper esophageal sphincter length (UESL) in the RD control group (P0.05), there was no significant difference in the relaxation times of the lower esophageal sphincter per hour in the GERD control group, and there was no significant difference in each relaxation time between the GERD control group and the GERD control group, and the difference was not statistically significant (P0.05) in the.6.RGERD group, there was no significant difference in the volume of the esophageal body parameters between the GERD control group and the GERD control group. There was no statistical significance (P0.05), and there was no significant difference between the group RGERD and the GERD control group, and there was no significant difference between the DL group and the DL group. The difference was not statistically significant (P0.05), and the incidence of depression in the.7.RGERD group was significantly higher than that in the control group, and the incidence of depression was significantly higher than that in the control group (P0.05); the RGERD group was compared with the GERD control group of anxiety scale (SAS) and the self rating depression scale. Significantly higher than the control group, the difference was statistically significant (P0.05), compared with the GERD control group, the reflux disease questionnaire (RDQ) scores were significantly higher than the control group, the difference was statistically significant (P0.05). Conclusion: 1, the number of weak acid reflux increased in the RGERD group and the GERD control group increased, the number of long acid reflux increased and the number of near end reflux increased, which could lead to the inhibition of PPI inhibition. In group RGERD, the number of reflux and the number of reflux of liquid gas in the GERD control group increased and the reflux symptoms increased. The lower esophageal sphincter length (LESL) in RGERD group was shorter than that of the GERD control group, and the lower esophageal sphincter pressure (LESP) was lower, and the upper esophageal sphincter pressure (UESP) was lower, indicating that the esophagus was included in the pathogenesis of RGERD, including the lower esophageal sphincter pressure (UESP). The length of the muscle, pressure and the pressure of the upper esophageal sphincter played an important role in.4. Group RGERD had anxiety and depression in the GERD control group, suggesting that psycho psychological factors were involved in the pathogenesis of RGERD.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R571

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