食管内灌酸对慢性咳嗽患者气道阻力与咳嗽敏感性的影响

目的观察向食管下段灌注盐酸对慢性咳嗽患者咳嗽症状、咳嗽敏感性和气道阻力的影响。方法17例慢性咳嗽患者经鼻插入5F胃管至食管下段，注入0．1N盐酸共10min，于灌酸前后测量肺通气功能、气道阻力和辣椒素咳嗽激发试验，记录灌酸期间患者自觉症状、咳嗽次数。比较灌酸前后咳嗽症状、咳嗽敏感性和肺通气功能、气道阻力的变化。结果灌酸后呼吸阻抗Zrs、中央气道阻力R20显著增高，差异有统计学意义（P〈0．05）；第1秒钟用力呼气容积（FEV1），用力肺活量（FVC）、共振频率（Fres）及外周气道阻力（R5-R20）无显著性变化（P〉0．05）；灌酸前后患者咳嗽敏感性也无显著性差异。相关分析显示，远端电极多项反流指标与灌酸总量呈显著负相关（P〈0．05），而与停止灌酸后pH值恢复正常的时间呈显著正相关（P〈0．05或P〈0．01）。结论向慢性咳嗽患者食管下段灌注盐酸可使气道阻力增加，尤其是中央气道阻力，这可能与胃食管反流诱发咳嗽有关。

Effects of esophageal acid perfusion on airway resistance and cough responsiveness in patients with chronic cough

Objective The purpose of this study was to assess the effect of distal intra-esophageal acid instillation on airway resistance and cough responsiveness in patients with chronic cough. Methods In seventeenth patients with chronic cough,intra-esophageal acid instillation was performed through an 5F tube filled with 0. 1 N hydrochloric acid （HC1） for 10 min. Simultaneously, esophageal pH was monitored by continuous esophageal pH monitoring, airway resistance, lung function and cough responsiveness was measured before and after acid instillation. Results The Zrs,R5 of total airway resistance, R20 of central airway resistance were significantly increase in before acid instillation than after acid instillation（ P 〈0.05）. However,no significant changes were observed either in cough responsiveness, FEV1 ,FVC,Fres or R5-R20 before and after acid instillation. Conclusions The present data demonstrate that an increase in airway resistance,special in central airway resistance, may be induced by HCl stimulates the distal esophagus in patients with chronic cough, suggesting that the gastro-esophageal reflux would be one of the important factors that induce cough.