使用 pH 值和阻抗监测评估先天性食管闭锁患儿的胃食管反流。
Evaluation of Gastroesophageal Reflux in Children Born With Esophageal Atresia Using pH and Impedance Monitoring.
机构信息
Department of Pediatric Surgery and Intensive Care Children, Erasmus MC University Medical Center - Sophia Children's Hospital.
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam.
出版信息
J Pediatr Gastroenterol Nutr. 2019 Nov;69(5):515-522. doi: 10.1097/MPG.0000000000002468.
OBJECTIVES
The aim of the study was to evaluate acid and nonacid gastroesophageal reflux in infants and school-aged children with esophageal atresia (EA) using pH-impedance (pH-MII) monitoring.
METHODS
Between 2012 and 2017, all 24-hour pH-MII studies performed in infants (≤18 months) and 8-year olds with EA were included. Antiacid therapy was discontinued before study. Exclusion criteria were: isolated tracheoesophageal fistula; esophageal replacement therapy; tube feeding; and monitoring <18 hours. Automatically detected retrograde bolus movements (RBM) were manually reviewed and modified/deleted if necessary.
RESULTS
We included 57 children (51% boys; 2% isolated EA; 44% thoracoscopic EA repair): 24 infants (median age 0.6 years) and 33 school-aged children (median age 8.2 years). Of the automatically detected 3313 RBM, 1292 were manually deleted from the tracings: 52% of nonacid RBM and 8% of acid RBM (mainly misinterpreted swallows or 1 event recognized as several events). In infants, median reflux index (RI; pH <4) was 2.6% (abnormal in n = 2), median RBM was 61 (62% nonacid, 58% mixed), and median of the mean BCT was 11 seconds. In older children, median RI was 0.3% (abnormal in n = 4), median RBM was 21 (64% nonacid; 75% mixed), and median of the mean BCT was 13 seconds.
CONCLUSIONS
Most children with EA off medication have a normal RI, yet experience a significant number of nonacid RBM. After manual revision of the tracings, a high percentage of RBM was deleted. Our data show that automated impedance analysis software needs refinement for use in infants and children with EA and question the need for standard antiacid therapy in these patients.
目的
本研究旨在通过 pH 阻抗（pH-MII）监测评估食管闭锁（EA）婴儿和学龄儿童的酸和非酸胃食管反流。
方法
2012 年至 2017 年间，纳入所有接受 24 小时 pH-MII 研究的≤18 个月婴儿和 8 岁 EA 患儿。研究前停止抗酸治疗。排除标准为：单纯气管食管瘘；食管替代治疗；管饲喂养；监测时间＜18 小时。自动检测到逆行食团运动（RBM）后，手动进行复查，并在必要时修改/删除。
结果
共纳入 57 例患儿（男 51%，单纯 EA 2%，胸腔镜 EA 修复术 44%）：24 例婴儿（中位年龄 0.6 岁）和 33 例学龄儿童（中位年龄 8.2 岁）。在自动检测到的 3313 次 RBM 中，1292 次手动从描记图中删除：非酸性 RBM 占 52%，酸性 RBM 占 8%（主要为误判的吞咽或 1 次事件被识别为多次事件）。婴儿组的中位反流指数（RI；pH＜4）为 2.6%（异常 2 例），中位 RBM 为 61 次（62%非酸性，58%混合性），平均 BCT 中位数为 11 秒。在年龄较大的儿童中，中位 RI 为 0.3%（异常 4 例），中位 RBM 为 21 次（64%非酸性；75%混合性），平均 BCT 中位数为 13 秒。
结论
大多数停药的 EA 患儿 RI 正常，但经历了大量的非酸性 RBM。经描记图手动修正后，大量 RBM 被删除。我们的数据表明，自动阻抗分析软件需要进一步改进，以便在 EA 婴儿和儿童中使用，并质疑这些患者是否需要标准的抗酸治疗。
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