窒息后新生儿胃食管返流的初步观察

目的探讨新生儿窒息对胃食管返流(GER)的影响.方法用便携式24 h pH记录仪动态监测30例不同程度窒息后新生儿和15例对照新生儿的24 h食管pH值.结果窒息组胃食管返流的各项参数均明显高于对照组,其中返流指数窒息组/对照组为7.8/1.9,返流次数为139/31,返流＞5 min的次数6.1/0.9,pH＜4总时间162/21,差异均有非常显著意义(P＜0.01).重度窒息组各项返流指数明显低于轻度窒息组和对照组(P＜0.01).结论新生儿窒息可引起胃肠运动功能紊乱,窒息后新生儿胃食管返流较对照组明显增加,应及时给予相应的处理.     

窒息后新生儿24小时食管PH值的动态观察

[目的] 探讨出生窒息对新生儿胃肠运动的影响。[方法] 用便携式24hPH记录仪动态监测30例不同程度窒息后新生儿和15例对照新生儿的24h食管PH值。[结果] 窒息组反映胃食管返流的各项参数均明显高于对照组，其中返流指数窒息组/对照组为7．8／1．9，返流次数为139/31。返流＞5min的次数6．1/0．9，最长返流时间25．1／4．5；PH＜4总时间162／21，差异均有非常显著意义(P＜0．01)。重度窒息组各项返流指数明显低于轻度窒息组(P＜0．01)。[结论] 窒息后新生儿胃食管返流较对照组明显增加，应及时给以相应的治疗。     

脑性瘫痪儿童胃食管返流的研究

[目的]探讨脑性瘫痪对胃食管返流的影响,为临床及时干预提供依据.[方法]利用便携式食管24h连续PH动态监测仪分别检测20例脑性瘫痪组儿童及20名无胃食管返流症状儿童的24 h食管PH值.[结果]脑性瘫痪组儿童的各项参数均明显高于对照组,两组总PH值＜4的时间百分比(%)脑性瘫痪组、对照组分别为(15.89±11.04)与(1. 88±1. 01)、酸性返流发生的总次数为(次/24 h)309.02±165.60与14.73±7.20、返流持续超过5 min的次数为(次/24 h)5.64± 3.52与1. 02±0.90、返流持续的最长时间(min)为23.38±1 3.40与4.50±1.90、DeMeester评分为61. 42±58.15与2.20±3.50,差异均有非常显著性(P＜0.01).[结论]脑性瘫痪可以引起胃食管返流,应及时给予干预治疗.     

西宁地区剖宫产新生儿两种吸痰方法效果观察

目的:研究深吸及浅吸两种吸痰方法对剖宫产新生儿的影响。方法:选择2007年3~12月在青海省人民医院出生的剖宫产新生儿320例,按住院先后随机分为研究组和对照组,每组160例。研究组采用深吸法清理呼吸道、食管、胃内黏液及羊水;对照组采用口鼻、咽喉部浅吸法清理呼吸道。两组均为母婴同室、母乳喂养。记录新生儿体重下降的最低幅度和回升时间、经皮总胆红素值、新生儿24 h呕吐次数及首排黄便时间。结果:研究组体重下降幅度明显低于对照组(P<0.01),体重回升快(P<0.05);24 h内呕吐次数明显少于对照组(P<0.01);首次排黄便时间早于对照组(P<0.01);黄疸程度明显低于对照组(P<0.01);差异均有统计学意义。结论:对剖宫产新生儿采用深吸法清理呼吸道、食管、胃内黏液及羊水可以减少新生儿呕吐次数,减轻生理性体重下降幅度,缩短胎便的排净时间,减轻黄疸程度。     

食管pH值监测对胃食管反流病的诊断价值

目的:评价24h食管pH值监测、胃镜检查、胃食管反流病问卷调查(GerdQ)在胃食管反流病中诊断价值。方法:40例初诊为烧心、反流的患者,分别予以24h食管pH值监测、胃镜检查、胃食管反流病问卷调查。结果:食管pH值监测灵敏度0.9722,特异度1,Youden指数0.9722;GerdQ灵敏度0.7778,特异度0.25,Youden指数0.0278;胃镜检查灵敏度0.833,特异度0.75,Youden指数0.583。24h食管pH值监测较胃食管反流病问卷(GerdQ)有显著差异(P0.05);24h食管pH值监测较有胃镜检查显著差异(P0.05)。结论:24h食管pH值监测在胃食管反流病中诊断价值明显高于胃镜检查、胃食管反流病问卷调查(GerdQ)。     

四磨汤口服液加非营养性吸吮对早产儿胃食管反流的影响

目的:观察四磨汤口服液加非营养性吸吮(NNS)对早产儿胃食管反流(GER)的影响。方法:将47例需经鼻饲管喂养(INGF)的健康早产适于胎龄儿,用同一种配方乳喂养。根据是否辅以四磨汤口服液加非营养性吸吮随机分为非营养性吸吮组(NNS)和单纯鼻饲管喂养组(N-NNS)。记录入液量、奶量、热卡及肠道营养达418.4kJ/(kg.d)的时间,记录喂养相关情况;同时进行食管24hpH值监测,记录以下指标:24h内总反流次数;反流指数(RI);反流持续时间5分次数;pH4总时间;最长酸反流时间。结果:四磨汤组24h内反流次数明显少于对照组分别为6(0～24)次,13(6～28)次,P0.05;pH4的总时间和反流指数与对照组比较明显下降;肠道营养达418.4kJ/(kg.d)的时间比对照组明显缩短分别为(10.24±3.83)天,(15.75±4.55)天,P0.05。结论:早产儿鼻饲管喂养期间给四磨汤口服液加非营养性吸吮是一种安全简单的辅助喂养方法,可有效的减少胃食管反流次数,对胃肠动力发育有促进作用,有助于早产儿生后肠道营养的建立。     

红霉素与吗丁啉对新生儿胃食管反流的干预治疗

目的观察红霉素与吗丁啉对新生儿胃食管反流的改善情况。方法将80例经24小时食管内PH监测诊断为胃食管反流新生儿随机分成红霉素组和吗丁啉组,分别用红霉素(5mg/(Kg.d)分3次)及吗丁啉(0.3mg/(Kg.次)每日3次)餐前口服进行干预,治疗后10天进行24小时食管内PH监测分析。结果①红霉素组与吗丁啉组在治疗后各项反流指标较治疗前均有明显改善,差异均有显著性(P<0.01);②两种药物间在治疗前、后的各项反流指标差异均无显著性(P>0.05);研究中吗丁啉组未见椎体外系症状,红霉素组未见肠道菌群失调及肝功能损伤。结论红霉素与吗丁啉均能改善新生儿胃食管反流程度,应根据情况合理选用。     

西沙比利治疗新生儿胃食管返流综合征42例临床疗效观察

目的观察西沙比利治疗新生儿胃食管返流征的临床疗效.方法对随机选取的42例新生儿胃食管返流征用西沙比利治疗(治疗组)与对照组40进行临床疗效观察对比.结果治疗组疗效与照组相比较,有显著性差异(x2=12.18,P＜0.01).结论西沙比利治疗新生儿胃食管返流征有确切疗效.     

血糖动态变化与窒息新生儿病情及预后的关系

目的:探讨血糖水平与窒息新生儿病情严重程度及预后的关系。方法:选取轻度窒息组46例,重度窒息组29例,对照组30例,分别于出生后1～6 h、7～12 h、13～18 h、19～24 h及24 h以后各测定患儿指、趾端末梢血血糖1次,进行统计学分析。新生儿血糖值在2.2～7.0 mmol/L之间为正常,<2.2 mmol/L为低血糖,>7.0 mmol/L为高血糖。结果:出生后1～6 h 3组新生儿血糖值差异有统计学意义(F=3.74,P<0.05),重度窒息组血糖值显著高于轻度窒息组和对照组(分别为q=3.91、4.46,P<0.05、0.01),轻度窒息组血糖值也显著高于对照组(q=3.52,P<0.05)。窒息新生儿6 h内血糖值与窒息程度间呈正相关(r=0.574,P<0.01)。在1～6h和7～12 h内,血糖类型在不同组间有显著性统计学差异(分别为H=15.291、6.401,P<0.05、0.01),重度窒息组血糖异常以高血糖为主,与对照组和轻度窒息组之间的差异均有统计学意义(分别为P<0.01、0.05)。其他时间段内组间差异未见有统计学意义(P>0.05)。结论:加强窒息新生儿早期血糖监测,及时处理高血糖,维持血糖稳定,对于减少血糖异常引起的脑损伤进而改善患儿的预后十分重要。     

围产期窒息新生儿血清肌酸磷酸激酶的临床意义探讨

目的:探讨围产期窒息新生儿血清肌酸磷酸激酶(CPK)的临床意义。方法:用酶偶联测定法分别检测122例窒息新生儿及20例健康对照组24h内血清CPK水平并进行分析。结果:窒息组血清CPK均高于对照组(P<0.01);42例窒息儿并发新生儿缺血缺氧性脑病(HIE),其CPK值明显高于其它未并发HIE的窒息新生儿(P<0.01)。其中16例并发中-重度HIE,26例并发轻度HIE,并发中-重度HIE的CPK值明显高于并发轻度HIE的窒息儿(P<0.01);39例窒息新生儿并发多脏器功能不全(MODS),并发MODS的窒息新生儿的血清CK明显高于未并发MODS的窒息新生儿。结论:测定围产窒息新生儿的血清CPK有助于预测窒息新生儿并发HIE及MODS的可能性,有助于HIE的临床分度。     

Esophageal abnormalities in patients with chest pain and normal coronary angiograms

AIMS: To evaluate the frequency and the variety of esophageal abnormalities in patients with chest pain and normal coronary angiograms. PATIENTS AND METHODS:: We have conducted a prospective study including patients with noncardiac chest pain based on normal coronary angiograms. We performed for all patients an upper gastrointestinal endoscopy, 24-hour esophageal pH monitoring and stationary esophageal manometry. RESULTS: Fifty patients were studied on a 3-year period (24 men and 26 women, mean age: 51.5 years). Gastroesophageal reflux disease was found on 24-hour esophageal pH monitoring in 29 patients (58%), associated with a good symptomatic correlation in 17 patients (34%). Esophageal motor disorders as nutcracker esophagus and diffuse esophageal spasm were found in 6 patients (12%) associated with gastroesophageal reflux disease in two cases. Independent factors associated with gastroesophageal reflux disease and esophageal motor disorders were respectively presence of regurgitations (p = 0.005 : adjusted OR[IC95%] : 3.57 [1.28 - 16.66]) and age higher than 58 years (p = 0.01 : adjusted OR[IC95%]: 2.77 [1.33 - 12.50]). CONCLUSIONS: Gastroesophageal reflux disease is the most common esophageal abnormality n; patients with noncardiac chest pain. In the absence of regurgitations, 24-hour esophageal pH monitoring must be the first test to be performed.     

24小时食管pH监测对胃食管反流病的诊断意义研究

目的探讨24h食管pH值与胃食管反流之间的关系,为临床诊治胃食管反流病提供科学依据。方法用CTD-svnectics公司便携式动态pH监测仪,对52例有胃食管反流症状者进行24h食管pH监测。采用Johson和DeMeester6种参数指标．对患者进行综合评分以反映病人的反流程度。结果监测病例组6种参数指标均显著高于对照组（P〈0．01）;DeMeester评分〉14．72．总阳性率为57．7％;以pH〈4的反流次数诊断阳性率最高（57．7％）,卧位pH〈4的总时间诊断阳性率最低（15．4％）。结论24h食管pH监测给反流性疾病的诊断和药物治疗提供了依据,提高了对胃食管反流疾病的认识和治疗效果。     

食管粘膜胃全层吻合——贲门成形术后抗胃食管返流功能的临床流行病学研究

作者设计并在临床上了一种新的手术方法以预防食管贲门癌手术后的胃食管返流。１９９４年４月－１９９５年１２月随机抽取３４例作实验研究组，同期使用吻合器吻合的２７例为对照组，术后进行了观察，监测和随访。研究组病例无胃食管返流症状，食管镜检查，钡餐造影无明显返流。     

Findings of 24-hour esophageal pH monitoring in patients with respiratory and otorhinolaryngologic manifestations of gastroesophageal reflux disease

We conducted a retrospective study on 24-hour esophageal pH monitoring performed to patients with non allergic asthma, chronic cough and chronic pharyngitis or laryngitis. We studied 168 patients. On 24-hour esophageal pH monitoring, gastroesophageal reflux was detected in 67 cases (40%), more frequently in patients with chronic cough and asthma than in patients with chronic pharyngitis or laryngitis. A statistically significant increase in all the pHmetric parameters, except for the number of reflux episodes, was found in asthmatic patients compared to patients with chronic pharyngitis or laryngitis. Comparison of the pHmetric parameters in patients with gastroesophageal reflux disease revealed that the number of reflux episodes of morethan five minutes and the duration of longest reflux episodes were higher in asthmatic patients than in patients with chronic cough. Gastroesophageal reflux disease is more frequent in asthma and chronic cough than in chronic pharyngitis or laryngitis. Reflux episodes in chronic cough are shorter than these in asthma. This difference should explain the different severity between the two situations.     

Initial validation of a questionnaire for detecting gastroesophageal reflux disease in epidemiological settings

There is a high prevalence of gastroesophageal reflux disease (GERD) in the general population. Prevalence studies are scarce, and there is a lack of valid instruments for measuring them. The aim of this paper is to validate a questionnaire for detecting GERD. A validity study design with pathologic GERD patients and controls was used. A sample of 240 subjects age and sex paired was selected in the ratio of 3:1 (patients to controls). The initial structured questionnaire contained a variety of GERD symptoms. Internal consistency, interobserver reliability, criteria validity using 24-h esophageal pH monitoring, construct validity, and extreme group validation were assessed. Sensitivity, specificity, and predictive values were also obtained in different cutoff points of the definitive scale. A total of 180 confirmed GERD patients and 60 controls were included in the study. Mean age in years was 45 +/- 13, with no statistical difference by gender (67% were female). Internal consistency of 0.75 and interobserver reliability of 0.87 was achieved in building the scale. Extreme group validation was highly significant by assessing the scale score with 24-h esophageal pH monitoring (P <.0001). At cutoff point 3 of the scale and with a correct classification of subjects of 92.4%, sensitivity, specificity, positive, and negative predictive values were 92, 95, 98, and 79%, respectively. The conclusion of this article is that a reliable and valid instrument was built to detect GERD.     

嗳气症患者24h多通道食管阻抗-pH监测的临床研究

目的嗳气症患者进行24h多通道食管阻抗-pH监测,观察不同亚型嗳气症患者的监测结果,探究不同亚型嗳气症患者的胃食管反流模式,评估该技术在嗳气症中的临床价值。方法根据罗马Ⅲ的定义,将115例嗳气症患者分为吞气症（组Ⅰ）39例和非特异性过度嗳气（组Ⅱ）76例。所有患者进行24h多通道食管阻抗-pH监测,观察不同亚型嗳气症患者的反流物性状、反流类型及嗳气类型。结果两组患者在年龄、性别方面无明显差异,且总反流次数、反流物性状和反流类型在两组间差异无统计学意义。组Ⅰ胃内型嗳气较非特异性过度嗳气（组Ⅱ）明显减少（P〈0.001）,胃上型嗳气则明显增多（P=0.008）。结论不同亚型嗳气症患者的发生机制不同,需进行个体化治疗。24h多通道食管阻抗-pH监测是评估嗳气症患者的重要诊疗手段。     

Laparoscopic treatment of gastro-esophageal reflux by fundoplication

The aim of this retrospective study was to evaluate the results of the laparoscopic fundoplication for gastroesophageal reflux disease. From January 1997 to February 2001, we performed 8 laparoscopic fundoplication. They are 5 men and 3 women with mean age of 45 [30-67 years]. The delay of apparition the symptoms varied from 6 months to 14 years. Seven patients had a heart burn. The preoperative evaluation included endoscopy, gastrointestinal contrast radiography, 24 hour pH monitoring and esophageal manometry. The surgical procedures were partial fundoplication (Toupet) in 7 cases and complete fundoplication (Nissen) in 1 case. There was no postoperative mortality. Two patients had a postoperative dysphagia. Two patients had persistent epigastric pain without gastroesophageal reflux in endoscopy and esophageal manometry. Laparoscopic fundoplication for treatment of gastroesophageal reflux disease is a safe and effective procedure with satisfying results.     

慢性阻塞性肺疾病并呼吸衰竭患者经持续气道内正压通气治疗后反流性咳嗽两种诊断方法的探讨

目的 探讨慢性阻塞性肺疾病(COPD)并呼吸衰竭患者经持续气道内正压(CPAP)通气治疗后反流性咳嗽24h食管pH值监测及质子泵抑制剂(PPI)试验性治疗两种诊断方法的临床价值.方法 选择COPD并呼吸衰竭经CPAP通气治疗后出现反流性咳嗽患者27例,采用随机数字表法分为两组,24h食管pH值监测组11例,PPI试验性治疗组16例.结果 24h食管pH值监测组诊断反流性咳嗽9例,阳性率81.82％(9/11);PPI试验性治疗组诊断反流性咳嗽14例,阳性率87.50％(14/16).两组阳性率比较差异无统计学意义(P＞0.05).结论 COPD并呼吸衰竭患者经CPAP通气治疗后出现反流性咳嗽,行PPI试验性治疗的诊断准确率高,抗反流治疗疗效好,方法 简单,易操作,较好地适用于COPD并呼吸衰竭危重患者,比24h食管pH值监测更有临床应用价值适宜在基层医院推广.     

Bilirubin as a tracer for detecting gastroesophageal reflux

PURPOSE: The usefulness of intraesophageal monitoring of bilirubin, in diagnosing gastroesophageal reflux, was studied. PATIENTS AND METHODS: Bilirubin concentration and pH at 5 cm oral and anal to the esophagogastric junction were monitored for 24 hours in 19 patients with reflux esophagitis. The duration of bilirubin presented and pH less than 4.0 were obtained as the holding time (HT) of bilirubin and acid, respectively. RESULTS: There was no difference between HT of bilirubin and acid in the stomach and esophagus. In the stomach, HT of bilirubin did not correlate with acid. Whereas, in both of bilirubin and acid, HT in the esophagus correlated significantly with that in the stomach. The correlation was more definite for bilirubin than acid. CONCLUSIONS: Bilirubin and acid presented in the upper stomach for sufficient period independently. Bilirubin monitoring was useful to evaluate the etiology of damaging the esophageal mucosa and causes of symptoms by estimating duodenogastro-esophageal reflux, which has synergistic effect with acid.