摘要
目的观察餐后不同时间段的膈肌训练对胃食管反流病（GERD）患者食管酸暴露、食管动力学和近端胃容积的影响。方法对象为2005年6月至2006年6月于北京协和医院就诊的30例GERD患者和9名健康对照。采用随机数字表将GERD患者随机分为3组：餐后第1小时膈肌训练组（DT1b组）、餐后第2小时膈肌训练组（DT2h组）和餐后不进行膈肌训练组（N-DT组）。DT1h、DT2h、N—DT和健康对照组4组间人口学特征匹配。应用DentSleeve测压导管和pH监测电极，同步观察受试者空腹30min和餐后2h的食管酸暴露和食管动力学参数[下食管括约肌压（LESP）、食管胃结合部（EGJ）压和膈脚压]。测压期间于空腹，餐后0、30、60、90和120min进行超声胃容积测定。结果DT1h组患者餐后2h内食管pH〈4的时间百分比明显低于N．DT组[0．2％（0～4．1％）比6．6％（2．2％-18．2％），P〈0．05]，而DT2h组[3．7（0．1％～17．8％）]与N-DT组差异无统计学意义（P〉0．05）。DT，h组患者餐后第1小时的EGJ压和膈脚压均高于N—DT组[（44．4±8．1）比（16．2±4．5）mmHg，（38．2±4．2）比（9．8±4．5）mmHg，1mmHg=0．133kPa，均P〈0．05]。DT2h组患者餐后第2小时的EGJ压和膈脚压也均高于N-DT组[（53．2±7．5）比（14．0±3．7）mmHg，（48．2±6．3）比（8．9±2．7）mmHg，均P〈0．05]。各组LESP和餐后近端胃容积差异均无统计学意义（均P〉0．05）。结论试餐后第1小时进行膈肌训练可以有效控制餐后2h的食管酸暴露，其机制可能为EGJ区抗反流屏障的加强。膈肌训练为GERD的保守治疗提供了一种新的治疗手段。
Objective To explore the effects of postprandial diaphragm training （DT） on esophageal acid exposure, esophageal motility and proximal gastric volume at different postprandial periods in patients with gastroesophageal reflux disease （ GERD）. Methods Thirty GERD patients and 9 healthy subjects （HS） with matched demographic characteristics were enrolled from June 2005 to June 2006 at Peking Union Medical College Hospital. Esophageal manometry with a Dentsleeve catheter and simultaneous esophageal pH monitoring were recorded in a 30-min fasting period and a 120-min postprandial period. The GERD patients were divided into 3 groups： 9 patients received diaphragm training at 1st hour after meal （ group DT1 h ） and another 10 at 2nd hour after meal （ group DT2 h ） whereas no diaphragm training after meal in 11 （group NDT）. Ultrasonic imaging of proximal gastric volume was undertaken at 0, 30, 60, 90 and 120 min after meal. Results （ 1 ） The percentage time with pH 〈 4 in group DT1 h was lower than that in group NDT in the 120-min postprandial period （0. 2% （0 -4. 1% ）, 6. 6 % （2. 2% - 18. 2% ）, P 〈 0.05 ） and no significant difference of esophageal acid exposure was observed between groups DT2 h and NDT （3.7%（0. 1%-17.8%）,6.6%（2.2% -18.2%）, P〉0.05）. （2） Esophagogastricjunction （EGJ） and crural diaphragm pressures at the l＇t hour after meal in group DT1 h were both significantly higher than those in group NDT during diaphragm training （（44.4±8.1 ） vs （16. 2 ± 4. 5）mm Hg, （38.2± 4. 2 ） vs（9.8 ±4. 5） mm Hg, 1 mm Hg =0. 133 kPa, both P 〈0. 05）. EGJ and crural diaphragm pressures at the 2nd hour after meal in group DTz h were significantly higher than those in group N-DT during diaphragm training （ （53.2 -＋7.5） vs （ 14. 0 ±3.7） mm Hg, （48.2±6. 3） vs （8.9±2. 7） mm Hg, both P 〈0. 05）. There was no change of lower esophageal sphincter pressure （ all P 〉 0. 05 ）. （ 3 ） After test meal, the groups D
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第40期3215-3219,共5页
National Medical Journal of China
关键词
胃食管反流
膈
食管
食管动力
Gastroesophageal reflux
Diaphragm
Esophagus
Esophageal motility
