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。

Twenty four hour esophageal pH monitoring of gastroesophageal reflux in children

The present study was undertaken to understand the usefulness of 24 hour esophageal pH monitoring for assessing gastroesophageal reflux (GER) and to investigate the diagnostic criterion for pathological GER in children. The 24 hour distal esophageal pH monitoring was carried out in 50 patients (aged 38 days to 13 years) with GER diagnosed by X ray, and in 30 asymptomatic children (control). The pH monitoring was repeated in 13 cases of pathological GER after antireflux treatment, including 9 patients treated with surgical therapy. The results showed that all parameters in GER patients were significantly higher than those in controls. According to this criterion 31 cases in 50 GER patients were considered to be pathological GER and the remaining 19 cases to be physiological GER, while 1 out of 30 control cases had pathological GER. Every parameters except for the number of reflux with pH<4 were higher in 13 patients with hiatal hernia (HH) than in simple pathological GER. In HH patients the number of reflux episodes (NRE) lasting for 5 min or longer, the duration of the longest episode (DLE), the percentage of time of pH<4 for total periods and mean duration of reflux episodes were higher at lying than at standing position ( P <0 05). In simple pathological GER patients the NRE lasting for 5 min or longer, the DLE and mean duration of reflux episodes were higher at lying than at standing position ( P <0 05), while the number of reflux at lying position was less than that at standing position. Pathological GER in children was more serious at lying position, especially in patients with HH. Twenty four hour esophageal pH monitoring was valuable in diagnosing and investigating GER and in evaluating the efficacy of treatment.