24 h食管pH监测在婴儿难治性肺炎中的临床应用研究

目的探讨24h食管pH监测在婴儿难治性肺炎中的临床应用及其意义。方法对57例难治性肺炎患儿进行24h食管pH监测,监测指标包括食管pH〈4.0的次数、反流时间≥5min的次数、最长反流时间、卧位pH值〈4的时间占总监测时间的百分比和Biox-Ochoa评分。结果57例中存在胃食管反流（GER）28例（占49.1%）;有呕吐与无呕吐症状患儿各项反流指标比较差异有统计学意义;伴有胃食管反流患儿经促动力剂治疗者,肺部罗音消失时间和咳嗽持续时间均较未用促动力剂治疗者短,差异有统计学意义（P〈0.05）。结论难治性肺炎患儿经正规抗炎治疗效果不佳者,应考虑是否合并胃食管反流,进行24h食管pH监测,以确定病因并指导治疗。

Clinical application of 24 hours esophageal pH monitoring in infant's refractory pneumonia

Objectives To study the clinical application and significance of 24-hour esophageal pH monitoring in infantile refractory pneumonia.Methods Twenty-four-hour esophageal pH monitoring was performed in 57 infants with refractory pneumonia to record the frequencies of pH < 4,the frequencies of refluxes lasting longer than 5 minutes,the longest episode of reflux,the percentage of time of pH < 4 at supine position,and Boix-Ochoa grade.Results Twenty-eight(28,49.1 %)of 57 infants were diagnosed as pathological gastroesophageal reflux(GER).All parameters were significantly higher in infants with repeat vomiting than those without vomiting(P < 0.05).The duration of rale heard and cough persisted were significantly shortened in GER infants treated with gastric motility promoting drug than those GER infants without treatment(P < 0.05).Conclusions Gastroesophageal reflux should be considered when there has no significant improvement for infants with refractory pneumonia after routine treatment,and 24-hour esophageal pH monitoring can be used to help making diagnosis.