多腔道阻抗联合pH监测对危重症患者胃食管反流的诊断价值研究
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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.
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.
引文
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[16]Condino AA,Sondheimer J,Pan Z,et al.Evaluation of infantile acid and nonacid gastroesophageal reflux using combined pH monitoring and impedance measurement[J].J Pediatr Gastroenterol Nutr,2006,42(1):16-21.
[17]Kantorova,Svoboda P,Scheer P,et al.Stress ulcer prophylaxis in critically iii patients:a randomizedcontrolled trial[J].Hepatogastroenterology,2004,51(57):757-761.
[18]Wang K,Lin HJ,Perng CL,et al.The effect of H2-receptor antagonist and proton pump inhibitor on microbial proliferation in the stomach[J].Hepatogastroenterology,2004,51(59):1540-1543.
[19]Xin Y,Dai N,Zhao L,et al.The effect of famotidine on gastroesophageal and duodenogastro-esophageal refluxes in critically ill patients[J].World J Gastroenterol,2003,9(2):356-358.
[20]Chen WS,Li S W,Peng SN,et al.Clinical diagnosis of gastroesophageal reflux in critically ill patients[J].Chin J Clin Gastroenterol,2013,25(5):307-309.
[21]Ibanez J,Penafiel A,Marse P,et al.Incidence of gastroesophageal reflux and aspiration in mechanically ventilated patients using small-bore nasogastric tubes[J].JPEN J Parenter Enteral Nutr,2000,24(2):103-106.
[2]Schallom M,Orr J,Metheny N,et al.Gastroesophageal reflux in critically ill patients[J].Dimens Crit Care Nurs,2013,32(2):69-77.
[3]Kadamani I,Itani M,Zahran E,et al.Incidence of aspiration and gastrointestinal complications in critically ill patients using continuous versus bolus infusion of enteral nutrition:a pseudorandomised controlled trial[J].Aust Crit Care,2014,27(4):188-193.
[4]Lee A,Festic E,Park PK,et al.Characteristics and outcomes of patients hospitalized following pulmonary aspiration[J].Chest,2014,146(4):899-907.
[5]DeLegge MH.Aspiration pneumonia:incidence,mortality,and at-risk populations[J].JPEN J Parenter Enteral Nutr,2002,26(6Suppl):S19-S24.
[6]Niederau C,Lubke H,Schumacher B,et al.Endoscopy in the intensive care unit[J].Z Gastroenterol,1994,32(8):465-469.
[7]Plaisier PW,van Buuren HR,Bruining HA.An analysis of upper GI endoscopy done for patients in surgical intensive care:high incidence of,and morbidity from reflux esophagitis[J].Eur J Surg,1997,163(12):903-907.
[8]Metheny NA,Clouse RE,Chang YH,et al.Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients:frequency,outcomes,and risk factors[J].Crit Care Med,2006,34(4):1007-1015.
[9]Sifrim D,Castell D,Dent J,et al.Gastro-oesophageal reflux monitoring:review and consensus report on detection and definitions of acid,non-acid,and gas reflux[J].Gut,2004,53(7):1024-1031.
[10]Wenzl TG.Evaluation of gastroesophageal reflux events in children using multichannel intraluminal electrical impedance[J].Am J Med,2003,115 Suppl 3A:161S-165S.
[11]Loots CM,Benninga MA,Davidson GP,et al.Addition of pHimpedance monitoring to standard pH monitoring increases the yield of symptom association analysis in infants and children with gastroesophageal reflux[J].J Pediatr,2009,154(2):248-252.
[12]Solana MJ,Sanchez C,Lopez-Herce J,et al.Multichannel intraluminal impedance to study gastroesophageal reflux in mechanically ventilated children in the first 48h after PICU admission[J].Nutrition,2013,29(7-8):972-976.
[13]Rosen R,Lord C,Nurko S.The sensitivity of multichannel intraluminal impedance and the pH probe in the evaluation of gastroesophageal reflux in children[J].Clin Gastroenterol Hepatol,2006,4(2):167-172.
[14]Sifrim D,Castell D,Dent J,et al.Gastrooesophageal reflux monitoring:review and consensus report on detection and definitions of acid,non-acid,and gas reflux[J].Gut,2004,53(7):1024-1031.
[15]Xu DT,Feng GJ,Zhao LL,et al.Comparison of various approaches for symptom assessment of gastroesophageal reflux disease[J].Chin J Pract Intern Med,2012,32(3):198-200.[徐定婷,冯桂建,赵丽莉,等.不同症状评估方式对胃食管反流病诊断价值比较研究[J].中国实用内科杂志,2012,32(3):198-200.]
[16]Condino AA,Sondheimer J,Pan Z,et al.Evaluation of infantile acid and nonacid gastroesophageal reflux using combined pH monitoring and impedance measurement[J].J Pediatr Gastroenterol Nutr,2006,42(1):16-21.
[17]Kantorova,Svoboda P,Scheer P,et al.Stress ulcer prophylaxis in critically iii patients:a randomizedcontrolled trial[J].Hepatogastroenterology,2004,51(57):757-761.
[18]Wang K,Lin HJ,Perng CL,et al.The effect of H2-receptor antagonist and proton pump inhibitor on microbial proliferation in the stomach[J].Hepatogastroenterology,2004,51(59):1540-1543.
[19]Xin Y,Dai N,Zhao L,et al.The effect of famotidine on gastroesophageal and duodenogastro-esophageal refluxes in critically ill patients[J].World J Gastroenterol,2003,9(2):356-358.
[20]Chen WS,Li S W,Peng SN,et al.Clinical diagnosis of gastroesophageal reflux in critically ill patients[J].Chin J Clin Gastroenterol,2013,25(5):307-309.
[21]Ibanez J,Penafiel A,Marse P,et al.Incidence of gastroesophageal reflux and aspiration in mechanically ventilated patients using small-bore nasogastric tubes[J].JPEN J Parenter Enteral Nutr,2000,24(2):103-106.
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