Sondheimer J M
Department of Pediatrics, University of Colorado Health Sciences Center, Denver.
Gastroenterology. 1989 Oct;97(4):821-6. doi: 10.1016/0016-5085(89)91484-4.
Thirty infants less than 12 mo old (19 with pathologic gastroesophageal reflux and 11 symptomatic controls) underwent continuous monitoring of distal esophageal pH with simultaneous pharyngeal and multiple-site esophageal manometry to compare acid clearance times of awake and asleep reflux episodes. While awake, acid clearance times of the two groups were equivalent. While asleep, mean acid clearance time increased in subjects with pathologic reflux greater than 500% while remaining essentially unchanged in symptomatic controls. No difference in minimum pH attained during sleep reflux, in percentage of swallows resulting in esophageal peristalsis, or in the frequency of secondary peristaltic waves was found to explain the difference in sleeping acid clearance times in the two groups. However, there was a significant difference between the groups with respect to swallowing rate (p less than 0.01). During sleeping reflux episodes, subjects with pathologic reflux swallowed 0.5 +/- 0.1 times per minute (mean +/- SEM), whereas controls who refluxed swallowed 3.5 +/- 1.3 times per minute. During awake reflux episodes the swallowing rates were equivalent in the two groups, 4.1 +/- 0.4 and 4.7 +/- 0.7 per minute, respectively. We conclude that low swallowing rate during sleeping reflux episodes is primary to the delayed clearance of sleeping reflux in these infants.
30名12个月以下的婴儿（19名患有病理性胃食管反流，11名有症状对照组）接受了远端食管pH值的连续监测，同时进行咽部和多部位食管测压，以比较清醒和睡眠反流发作时的酸清除时间。清醒时，两组的酸清除时间相当。睡眠时，病理性反流患者的平均酸清除时间增加超过500%，而有症状对照组基本保持不变。睡眠反流期间达到的最低pH值、导致食管蠕动的吞咽百分比或继发性蠕动波频率方面没有差异可以解释两组睡眠酸清除时间的差异。然而，两组在吞咽率方面存在显著差异（p小于0.01）。在睡眠反流发作期间，病理性反流患者每分钟吞咽0.5±0.1次（平均值±标准误），而反流的对照组每分钟吞咽3.5±1.3次。在清醒反流发作期间，两组的吞咽率相当，分别为每分钟4.1±0.4次和4.7±0.7次。我们得出结论，睡眠反流发作期间吞咽率低是这些婴儿睡眠反流清除延迟的主要原因。
