西沙比利治疗新生儿胃食管返流疗效观察

胃食管返流综合征（ｇａｓｔｒｏ－ｅｓｏｐｈａｇｅａｌｒｅｆｌｕｘ，ＧＥＲ）是指由于全身或局部原因引起食管下端括约肌（ＬＥＳ）功能不全，胃内容物返流至食管的一种病理状态；轻者引起不适、呕吐，重者则可引起食管炎及吸入综合征甚至窒息死亡。我院对３２例ＧＥＲ...     

哮喘反复发作与胃食管反流

本文报告支气管哮喘反复发作５６例，其中２９例出现胃食管反流症状和体位性痉咳及夜间呛咳喘气表现，认为胃食管反流（ＧＥＲ）的发生与患儿年龄、发作频率、治疗反应、病情轻重有关，药物的应用、ＬＥＳＰ的降低、低氧血症、高碳酸血症、食管粘膜缺氧、抗损伤能力下降、小儿对反流物清除速度缓慢是促进ＧＥＲ发生和发展的重要诱发因素。     

新生儿胃食管反流发病机理的研究

为探讨新生儿胃食管反流（ＧＥＲ）的发病机理，对３８例经钡餐造影诊为ＧＥＲ的患儿进行食管ｐＨ值动态监测和食管动力功能检查，１５例无症状儿作对照组。结果：ＧＥＲ组各项反流指标均显著大于对照组。３８例中１８例为生理性ＧＥＲ，２０例为病理性ＧＥＲ。病理性反流组下食管括约肌压力（ＬＥＳＰ）和屏障压（ＢＰ）均显著低于对照组，而食管功能的其他指标则差异无显著意义。以总ｐＨ值＜４百分时间２．７７％和综合评分８．９２为９５％参考值上限，则ＧＥＲ组病理性反流的检出率为５５．３％（２１／３８），高于对照组的６．７％（１／１５）（Ｐ＜０．０１）。ＬＥＳＰ和ＢＰ的９５％参考值下限分别为８．３９ｋＰａ、８．１５ｋＰａ，对照组无一例ＬＥＳＰ低下，ＧＥＲ组ＬＥＳＰ降低占１５．７％（６／３８），二组差异无显著意义（Ｐ＞０．０５）。提示：新生儿期食管功能已成熟，新生儿ＧＥＲ的发生不单是ＬＥＳＰ降低这一因素，还可能与短暂下食管括约肌松驰有关。     

儿童胃食管返流102例的临床分析

报道儿童胃食管返流（ｇａｓｔｒｏｅｓｏｐｈａｇｅａｌｒｅｆｌｕｘ，ＧＥＲ）１０２例，采用胃食管钡剂造影作为基本诊断方法。按５级分类法判断病变程度及ＧＥＲ合并症的类型。对儿童ＧＥＲ与并发其他疾病的关系等进行讨论，并对其临床及Ｘ线特点作回顾性分析。对象...     

动态24小时食管pH值监测小儿胃食管返流

为了解２４小时食管ｐＨ值监测在小儿胃食管返流（ＧＥＲ）诊治中的作用，研究小儿病理性ＧＥＲ的特点及其诊断标准，对５０例经钡餐造影诊为ＧＥＲ的患儿进行动态２４小时食管内ｐＨ值监测，３０例健康小儿为对照组，复查１３例病理性ＧＥＲ患儿治疗后（９例为手术治疗）的食管ｐＨ值。结果表明，ＧＥＲ组各项返流指标显著高于对照组。对照组中１例为病理性ＧＥＲ，ＧＥＲ组３１例为病理性，另１９例则为生理性。１３例食管裂孔疝（ＨＨ）患儿均有明显的病理性返流，其各项返流指标除ｐＨ值＜４次数外均显著高于单纯病理性ＧＥＲ；ＨＨ组卧位时返流≥５分钟次数、最长返流时间、总ｐＨ值＜４的时间占总观察时间的百分比和平均返流周期均显著大于立位时；单纯病理性ＧＥＲ组卧位时返流≥５分钟次数、最长返流时间和平均返流周期显著大于立位时，而返流次数则小于立位时。提示小儿病理性ＧＥＲ以卧位时明显，伴有食管裂孔疝者返流更为严重。动态２４小时食管内ｐＨ值监测可用于小儿ＧＥＲ的诊断、分析和疗效评定。     

小儿食管裂孔疝和胃食管返流的超声检查

介绍１４０例正常小儿和７例疑为胃食管返流（ＧＥＲ）患儿的食管腹腔部分和贲门的超声显像法、形态和测量值，说明Ｂ型超声和超声多普勒双功扫描不仅有助于对食管远端和贲门部生理状态的研究，也有助于食管裂孔疝和ＧＥＲ的诊断。     

早产儿胃电节律和胃食管反流的初步观察

目的 探讨早产儿胃电节律特点与胃食管反流（ＧＥＲ）的关系。西沙比利混悬液对ＧＥＲ的疗效。方法 １９９８年５月～１９９９年５月在我院产科分娩的早产儿４１例，其中男２３例、女１８例。用Ｄｉｇｉｔｒａｐｅｒ ＭＫⅢ型ＰＨ监测仪和Ｄｉｇｉｔｒａｐｅｒ胃电图（ＢＥＧ）检测仪进行食管２４ｈ ｐＨ监测及胃电图检测，根据腹部Ｘ线平片胃在体表投影确定胃体，胃窦的位置放置胃电图电极。喂奶前后各记录３０ｍｉｎ。良管２４     

24小时食管pH值监测在小儿支气管哮喘诊治中的应用

目的探讨胃食管返流（ＧＥＲ）与小儿支气管哮喘的关系，了解２４小时食管ｐＨ值监测在小儿哮喘诊治中的作用。方法用便携式２４小时ｐＨ自动记录仪，监测３８例支气管哮喘患儿食管下端ｐＨ值变化，３０例无症状儿为对照组，对１５例合并病理性ＧＥＲ患儿进行抗返流治疗，复查８例。结果哮喘组８项返流指标均显著大于对照组（Ｐ＜０．０１），其病理性ＧＥＲ的检出率为３９％（１５／３８），显著高于对照组（１／３０）（Ｐ＜０．０１）；小儿哮喘合并病理性ＧＥＲ者其返流以卧位和夜间时严重；经雷尼替丁抗返流治疗后，各项返流指标除了立位ｐＨ＜４时间百分比外，均显著下降（Ｐ＜０．０１或＜０．０５），近期随访结果显示，哮喘得到有效控制。结论ＧＥＲ是诱发小儿哮喘发作的一个重要因素，哮喘合并病理性ＧＥＲ的患儿对制酸药物抗返流治疗有良好的反应，２４小时食管ｐＨ值监测在小儿哮喘的病因诊断和疗效观察上有重要的应用价值。     

新生儿胃食管返流36例临床分析

新生儿胃食管返流３６例临床分析泉州市儿童医院（３６２０００）郑忠实黄思娥胃食管返流（ＧＥＲ）是指由于全身或局部原因引起下端食管括约肌功能不全，导致胃内容物返流入食管的一种常见临床表现，并可引起严重并发症。易发生于新生儿期，近年来已受到重视。现将我院１...     

食管壁细胞线粒体变化规律及临床意义

通过对１８～３１周胎儿食管下段（ＬＥＳ）及食管体环状平滑肌内线粒体超微结构电镜图像三维结构参数计算，发现随着胎儿月龄增加，ＬＥＳ平滑肌细胞内线粒体体密度（Ｖｖ）、面密度（Ｓｖ）、平均体积（　）及平均截面积（　）均增大，长短轴比（Ｑ）变小，数密度（Ｎｖ）变化不显著。ＬＥＳ平滑肌与食管体平滑肌相比，其细胞线粒体的Ｖｖ、Ｓｖ、Ｎｖ、　、　更大，而Ｑ较小。这是ＬＥＳ括约功能及其不断发育成熟的结构基础，也是防止胃食管返流机制逐渐发育完善的重要原因。     

近端食管胃酸反流与胃食管反流患儿呼吸道症状的关系

目的了解胃食管反流(GER)患儿近端食管胃酸反流与呼吸道症状发生的关系。方法采用食管双pH动态监测法，对31例单纯性呕吐、23例伴有反复呼吸道症状的GER患儿同时监测食管近端和远端pH值的变化，以35例健康儿作为对照组。结果单纯呕吐组远端食管各项酸反流指标、近端食管酸反流指标除最长反流时间外均大于对照组，差异有显著性；呼吸道症状组远端食管、近端食管各项酸反流指标均大于对照组，差异有显著性；但单纯呕吐组与呼吸道症状组相比较，无论在近端食管还是在远端食管，各项指标的差异无显著性；病例组远端食管各项酸反流指标均大于近端食管，差异有显著性。结论近端食管酸反流并不是GER患儿发生呼吸道症状的主要因素，而远端食管酸反流是小儿GER的主要反流形式。     

US in the diagnosis of gastroesophageal reflux in children

Several techniques have been used to diagnose gastroesophageal reflux (GER) in children, but no single test is sufficiently accurate to completely investigate the problem. Gastroesophageal US has been described as a widely available, noninvasive and sensitive method. It provides morphological and functional information, but its role in the diagnosis of GER in children is still debated. In this paper we review diagnostic approaches to GER in children. We focus on current use of US in the management of children with suspected GER. Reports suggest that US allows exclusion of several non-GER causes of symptoms and that it provides morphological and functional data with high sensitivity and positive predictive value for the diagnosis of GER. Sonographic assessment of findings such as abdominal esophageal length, esophageal diameter, esophageal wall thickness and gastroesophageal angle provide important diagnostic indicators of reflux and related to the degree of GER. There is a need for standardization of the procedure and for defining diagnostic criteria.     

Exercise-induced gastroesophageal reflux in an athletic child

Exercise-induced gastroesophageal reflux (GER) is described in an athletic child with chronic abdominal pain and vomiting in conjunction with strenuous exercise. Although continuous 24-h pH probe monitoring was negative for GER, simultaneous pH probe and exercise stress testing (treadmill) showed a prolonged, continuous episode of acid reflux throughout exercise and the 30-min recovery phase. The authors are unaware of other cases of exercise-induced GER in children and suggest that simultaneous pH probe and exercise stress testing may be a useful technique to evaluate exercise-induced symptoms in children. Moreover, the presence of acid reflux during stress may warrant exercise restriction during the early management of reflux esophagitis.     

联合食管多通道腔内阻抗-pH监测婴幼儿胃食管反流病

目的 评价24 h 联合食管多通道腔内阻抗-pH 监测（24 h MⅡ-pH）在婴幼儿胃食管反流病中的诊断价值,分析伴有反复肺炎的胃食管反流婴幼儿的反流特点。方法 疑诊胃食道反流的反复肺炎婴幼儿17 例,行24 h MⅡ-pH 监测,分析反流物性质和特点。结果 17 例患儿中阳性11 例（65%）,共监测到853 次反流周期,其中65.3% 为酸反流,以餐后2 h 以内发生为主（69.5%）;71.6%为混合反流;反流发生的体位从多至少依次为直立位、仰卧位、侧卧位和俯卧位;反流物的高度以远端反流为主。根据Biox-ochoa 评分,重度反流的患儿占73%（8/11）。结论 联合食管MⅡ-pH 监测可分析反流物性质,增加胃食道反流病的检出率。     

小儿哮喘与胃食管返流的研究

为探讨小儿哮喘与胃食管返流（ＧＥＲ）的关系，采用便携式ｐＨ自动记录仪对４１例反复发作的哮喘患儿进行了２４小时食管ｐＨ值监测，以２０例健康儿作为对照组。结果：哮喘组胃食管返流发生率为５３．７％（２２／４１），显著高于对照组（０／２０）；哮喘组Ｂｏｉｘ－Ｏｃｈｏａ综合评分、酸性返流指数、返流≥５分钟次数均显著大于对照组，而ｐＨ值＜４的次数、最长返流持续时间则与对照组差异无显著意义（Ｐ＞０．０５）。提示：反复发作的哮喘患儿胃食管返流发生率较高，哮喘与胃食管返流之间有密切的关系。     

Long-term radiographic follow-up of the Nissen fundoplication in children

This study examined 46 children 5–9 years (mean 6.7) after Nissen fundoplication surgery for gastroesophageal reflux (GER). Eleven were deceased and ten of the 35 families declined objective evaluation. The remaining 25 children (71%) had a barium swallow examination. In 16 of the 25 patients the fundoplication was intact. In 2 patients a small portion of the fundoplication was displaced above the diaphragm. In 5 patients there was residual esophageal disease. In 3 patients (one with esophageal disease), with a hiatus hernia prior to surgery, despite immediate postoperative reduction, the barium swallow examination done for this study revealed recurrent hiatus hernia but no GER. Long-term results of the Nissen fundoplication reveal success in eliminating clinically significant gastroesophageal reflux. Those patients with esophageal disease prior to the surgery need close interval follow-up to monitor continuing problems.     

The effects of gaviscon and metoclopramide in gastroesophageal reflux in children

Oral metoclopramide (0.5 mg/kg/24 h) and a liquid alginic acid-antacid compound were administered to infants and children with gastroesophageal reflux (GER) in a double-blind randomized controlled trial. The effect of medication was measured with 24-h intraesophageal pH monitoring. Neither metoclopramide nor the alginic acid-antacid compound decreased the frequency or duration of gastroesophageal reflux.     

Association of lipid-laden alveolar macrophages and gastroesophageal reflux in children

The association of lipid-laden alveolar macrophages (LLAM) and gastroesophageal reflux (GER) was investigated prospectively in 115 patients in two groups. Group 1 included 74 children with chronic respiratory tract disorders and documented GER by prolonged esophageal pH monitoring, barium esophagram, and esophagoscopy; group 2 included 41 children with chronic respiratory tract disorders without GER. LLAM were present in 63 (85%) and eight (19%) children from groups 1 and 2, respectively (P less than 0.0001). Thus a strong association between the presence of LLAM and GER in children with chronic respiratory tract disorders was established. We suggest that LLAM from bronchial lavage may be a useful marker for tracheal aspiration in children with GER in whom chronic lung disease may subsequently develop.