Davidson G P, Dent J, Willing J
Gastroenterology Unit, Adelaide Children's Hospital, North Adelaide, South Australia.
Gut. 1991 Jun;32(6):607-11. doi: 10.1136/gut.32.6.607.
In children technical limitations of upper oesophageal sphincter manometry have restricted investigation to the pull through technique under sedation. In this study we have used an adapted sleeve manometric technique for upper oesophageal sphincter monitoring in unsedated children and determined the influence of the state of arousal on upper oesophageal sphincter pressure. Twenty six children aged 3 to 42 months (median 17.5 months), who were referred for evaluation of oesophageal motor function, were studied with dual sleeve manometric assemblies which monitored upper and lower oesophageal sphincter pressures simultaneously. Pharyngeal, oesophageal body, and gastric pressures were also monitored with seven perfused side holes. Recordings were made for four hours after a meal and were technically successful in 24 children. The child's state of arousal was scored every 12th minute as follows: (A) resting, eyes closed, (B) resting, eyes open, (C) moving but comfortable, (D) restless and uncomfortable, (E) crying. In 67% of the 12 minute samples the children showed good adaptation to the procedure (arousal states A to C). There was a highly significant difference in upper oesophageal sphincter pressure between each of the arousal states (p less than 0.0001), being lowest in category A at (mean (SD) 18.1 (10.3) mmHg and highest in category D 55.7 (13.2) mm Hg. Abrupt changes in the state of arousal were associated with equally abrupt changes in upper oesophageal sphincter pressure. The state of arousal of unsedated children has an important influence on upper oesophageal sphincter pressure. It is essential that this factor is controlled for in any studies of upper oesophageal sphincter tone in children. The sleeve technique is capable of monitoring upper oesophageal sphincter motility for prolonged periods in unsedated children.
在儿童中，上食管括约肌测压的技术限制使得在镇静状态下只能采用牵拉技术进行研究。在本研究中，我们采用了一种改良的套囊测压技术，用于在未镇静的儿童中监测上食管括约肌，并确定觉醒状态对上食管括约肌压力的影响。对26名年龄在3至42个月（中位数17.5个月）因食管运动功能评估而转诊的儿童，使用双套囊测压组件进行研究，该组件可同时监测上、下食管括约肌压力。还通过七个灌注侧孔监测咽部、食管体部和胃内压力。饭后记录四小时，24名儿童的记录在技术上是成功的。每隔12分钟对儿童的觉醒状态进行评分如下：（A）休息，闭眼；（B）休息，睁眼；（C）活动但舒适；（D）烦躁不安且不适；（E）哭泣。在12分钟样本的67%中，儿童对该操作表现出良好的适应性（觉醒状态A至C）。各觉醒状态之间的上食管括约肌压力存在高度显著差异（p<0.0001），A类最低，平均（标准差）为18.1（10.3）mmHg，D类最高，为55.7（13.2）mmHg。觉醒状态的突然变化与上食管括约肌压力的同样突然变化相关。未镇静儿童的觉醒状态对上食管括约肌压力有重要影响。在任何关于儿童上食管括约肌张力的研究中，控制这一因素至关重要。套囊技术能够在未镇静的儿童中长时间监测上食管括约肌的运动。
