摘要
目的比较多腔道阻抗联合pH监测（MⅡ-pH监测）和单独pH监测两种方法对危重症患者胃食管反流（GER）的诊断价值。方法采用前瞻观察性研究方法,分析2013年7月-2014年12月间连续收入北京市海淀医院重症医学科（ICU）的住院患者。所有研究对象均行24h MⅡ-pH监测,记录并分析GER的相关参数,包括总反流次数、液体反流次数、酸性反流次数、反流暴露时间、反流清除时间等。比较MⅡ-pH监测结果中MⅡ-pH监测和单独pH监测对诊断GER的异同。结果 116例ICU住院患者中,MⅡ-pH监测识别出115例（99.1%）患者共发生5024次反流（43.28±3.96次/例,中位数34次/例,范围0~196次/例）,而单独pH监测识别出54例（46.6%）患者共发生1868次酸性反流（7.66±1.65次/例,中位数0次/例,范围0~81次/例）。MⅡ-pH监测的总反流次数中位数以及液体反流次数中位数（分别为34.0和30.5次）明显多于单独pH监测的反流次数中位数（0次）,差异有统计学意义（P=0.000）;MⅡ-pH监测到的总反流暴露时间中位数、平均反流清除时间中位数和最大反流清除时间中位数（分别为522、10、108s）均明显长于单独pH监测（分别为5.06、2.53、3.46s）,差异有统计学意义（P=0.000）。相关分析显示,单独pH监测的酸性反流次数与MⅡ-pH监测的总反流次数（r=0.119）以及液体反流次数（r=0.231）呈弱相关,而与MⅡ-pH监测的酸性反流次数无明显相关性（r=0.656）。结论在危重症患者GER的监测方法中,MⅡ-pH监测较单独pH监测更为敏感。
Objective To compare the diagnostic value of using 24-hour combined esophageal multichannel intraluminal impedance and pH monitoring（MII-pH） in the diagnosis of gastro-esophageal reflux（GER） and pH monitoring alone in critically ill patients. Methods A prospective observational study was performed including 116 critically ill adult patients admitted to ICU of Peking Haidian Hospital from Jul. 2013 to Dec. 2014. All the patients underwent 24-hour combined MⅡ-pH monitoring. GER episodes were recorded and its pH was recorded（acidic, weakly acidic and weakly alkaline） and its composition was recorded（liquid, mixed and gas reflux）. The results of the MⅡ-pH and the pH were monitored and compared. The demographic characteristics and clinical information were recorded. Results MⅡ-pH was monitored for 5024 episodes of GER in 115 of 116（99.1%） patients, with a mean of 43.28±3.96 episodes per patient（median, 34 episodes; range, 0-196 episodes）. The pH monitoring detected 1868 episodes（100% acid） in only 54 of 116（46.6%） patients, with a mean of 7.66±1.65 episodes per patient（median, 0 episodes; range, 0-81 episodes）. The number of episode of all reflux and liquid reflux diagnosed by pH monitoring alone was less than those diagnosed by MⅡ-pH monitoring（P=0.000）, and there was no correlation in the episodes number of all reflux and liquid reflux between the two techniques（r=0.119, 0.231）. Only a moderate correlation was found in the number of episodes of acidic reflux between the two techniques（r=0.656）. Conclusion MⅡ-pH monitoring is more sensitive than pH monitoring alone for establishing the diagnosis of GER.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2016年第5期412-415,共4页
Medical Journal of Chinese People's Liberation Army
基金
首都卫生发展科研专项基金(首发2011-7051-02)
北京市优秀人才资助项目(2012D008005000005)~~
关键词
危重病
胃食管反流
食管PH监测
critical illness
gastroesophageal reflux
esophageal pH monitoring
