Objective To explore the advantages of multiple channel intraluminal pH-impedance reflux monitoring (MII-pH) over single pH monitoring for the diagnosis of gastroesophageal reflux disease (GERD), and the characteristics of reflux episodes in patients with gastroesophageal reflux disease. Methods The data of adult GERD patients under MII-pH monitoring for the first time in our center between June 2015 and June 2017 was included. The positive rate of the main indicators of the pH channel and impedance channel of MII-pH monitoring, and the statistical relationships between the reflux indicators were analyzed. Results A total of 1780 patients with GERD were included, 889 of whom were males and 891 females, (51. 6 ± 12. 9) years old. There were 1026, 1045, 462, 258, 448, 370, and 540 cases of acid reflux, heart burning, belching, chest pain, cough, asthma, and globus sensation symptom, respectively. The positive rate of the pH channel was 26. 3％, of which the positive rate of De Meester score was 25. 4％, and that of acid exposure time (AET) was 25. 4％. The positive rate of the impedance channel was 69％, where the positive rate of total reflux volume was 21. 5％, the numbers of liquid acid reflux episodes and non acid reflux episodes were statistically different (P ＜ 0. 001), and there was statistically significant difference between the number of liquid acid reflux episodes and that of gas reflux episodes (P ＜0. 001). The positive rate of bolus exposure time (BET) was 40. 3％, and the positive rate of symptom reflux association was 53％.The total positive rate of MII-pH monitoring was 71. 3％. There was statistically significant difference (P ＜ 0. 001) and a statistically significant correlation (r = 0. 904＞ 0. 9, P ＜ 0. 001) between the number of acid reflux episodes of the impedance channel and that of the pH channel. The difference in McNemar chi square test of the positive rate of total reflux volume and symptom reflux association was statistically significant (P ＜ 0. 001, Kappa = 0. 15), so was the difference in McNemar chi square test of the positive rate of pH channel and symptom reflux association (P ＜ 0. 001, Kappa =0. 120). Conclusions MII-pH monitoring is highly consistent and more sensitive for detecting acid reflux episodes compared with single pH monitoring. Non-acid reflux and gas reflux episodes detected by the impedance channel of MII-pH monitoring can significantly improve the detection rate of GERD. Analysis of symptom reflux association can improve the detection rate of GERD and even reflux hypersensitivity (esophagus and airway).

目的 研究反流性喉痉挛(gastroesophageal reflux laryngospasm,GERL)的临床特点及其对综合诊治的反应.方法 纳入2010年1月至2016年6月连续住院,症状问卷调查符合喉痉挛发作特点,胃镜、 测压及24 h pH检查后行PPI、 食管贲门射频治疗或胃底折叠术后喉痉挛症状消失,随访观察12个月以上喉痉挛无发作而诊断为GERL的患者,统计分析GERL患者的gastroesophageal reflux disease(GERD)症状谱,喉痉挛发作特点、 检查结果及对抗反流治疗的反应.结果 本研究共纳入GERL患者64例,平均年龄48.9岁.71.9％患者伴有反酸、 烧心等典型GERD症状,75％的患者伴有咳嗽、 哮喘等食管外症状.35.9％患者主诉反酸可致呛咳,继而出现喉痉挛,73.4％的患者自觉餐后、 进食刺激性食物、 饱食或饮酒后喉痉挛多发,42.2％的患者喉痉挛多发于平卧睡眠中.24 h pH监测和胃镜检查的病理性酸反流和食管炎的检出率分别为53.1％和48.6％.本组有37.5％的患者对PPI的反应良好,51.6％有部分反应,10.9％对PPI反应不佳;84.4％的患者因不能停用PPI或PPI疗效不佳选择食管贲门射频治疗或胃底折叠术,取得了良好的疗效.结论喉痉挛可作为GERD的食管外表现之一.GERL患者可合并GERD的典型症状和/或食管外症状,部分患者可自觉喉痉挛发作与反流症状、 饮食、 体位等因素相关而有助于GERL的诊断.GERL通常对PPI、 射频治疗和胃底折叠术等抗反流治疗反应良好.

<正>呼吸、心跳骤停是临床上最严重的急症,因此,护士在抢救过程中,应做到判断准确、抢救及时、措施有力、从而提高抢救成功率[1]。因此,对护士的急救知识提出了更高的要求,通过自身的抢救经验,认为至少应做到以下几点:

我科于2006-10-31收治以胸闷,气喘为主要症状的男性患者1例,入科后经我科行电子胃镜,食管压力测定,24 h pH值监测后,确诊为胃食管反流病,慢性胃炎.于2006-11-08行Stretta微量电流射频治疗术,治疗后胸闷,气喘症状缓解,分析如下.