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。

Mechanisms of gastroesophageal reflux in neonates

The aim of this study was to examine the mechanisms of gastroesophageal reflux (GER) in neonates. The distal esophageal pH monitoring and esophageal motility function were performed in 38 patients with GER diagnosed by X ray barium meal examination, and 15 asymptomatic neonates as controls. The results showed that 18 cases had physiological reflux and 20 pathological reflux according to Boix Ochoa criterion. All parameters of GER group were higher than those of controls evidently. Lower esophageal sphincter pressure (LESP) and barrier pressure (BP) of pathological group were significantly lower than those of controls. Besides, other parameters of esophageal function were not significantly different between pathological group and control group. According to the criterion that regarding the total percent time of pH<4 less than 2.77 and Boix Ochos scores less than 8.92% as the lower limit of 95% reference valuss, 55.3% (21/38) of GER group were considered as pathological GER, which was significantly higher than the controls 6.7%(1/15)]( P < 0.01). The lower border of 95% values of LESP and BP was higher than 8.39kPa and 8.15kPa respectively, 15.7%(6/38) was considered as low LESP in GER group, which was not significantly different from controls (0%). These results suggest that neonatal esophageal motility function has been mature. GER in neonates was associated not only with a low basal LESP but also with transient inappropriate relaxation of the lower esophageal sphincter.