Feranchak A P, Orenstein S R, Cohn J F
Department of Pediatrics, Children's Hospital of Pittsburgh, PA 15213.
Clin Pediatr (Phila). 1994 Nov;33(11):654-62. doi: 10.1177/000992289403301104.
To identify behaviors associated with the onset of gastroesophageal reflux episodes in infants both systematically and prospectively, each of 10 patients (aged 2 to 32 weeks) was studied during 2 hours of intraluminal esophageal pH probe monitoring, using a split-screen audiovisual recording technique. Videotape analysis of eight infants who had scoreable reflux events revealed six discrete behaviors closely associated temporally (P < .001 to < .05) with the onset of reflux events: "discomfort" (crying or frowning), "emission" (of liquid or gas, i.e., regurgitation, drooling, or burping), yawning, stridor, stretching, and mouthing. Three behaviors (hiccuping, sneezing, and thumb-sucking) were infrequent but were significantly associated with onset of reflux events in one or two patients each. A tenth behavior, coughing or gagging, was significantly associated with onset of reflux events in two patients, but not in the rest, despite relatively frequent occurrence. Exploration of temporal relations between reflux and each behavior suggested that discomfort, emission, mouthing, and cough-gag may have caused reflux episodes, and that all 10 of the behaviors may have been caused by reflux episodes. These findings and a "quiet period" immediately preceding episodes in six of the infants suggest interesting pathophysiologic mechanisms in infants which require further evaluation.
为了系统且前瞻性地识别与婴儿胃食管反流发作相关的行为，对10名患者（年龄2至32周）中的每一位进行了2小时的腔内食管pH探头监测，并采用分屏视听记录技术。对8名有可评分反流事件的婴儿进行录像带分析，发现6种离散行为在时间上与反流事件的发作密切相关（P <.001至<.05）：“不适”（哭闹或皱眉）、“排出”（液体或气体，即反流、流口水或打嗝）、打哈欠、喘鸣、伸展和做口型。三种行为（打嗝、打喷嚏和吮拇指）很少见，但分别在一两名患者中与反流事件的发作显著相关。第十种行为，咳嗽或作呕，在两名患者中与反流事件的发作显著相关，但在其他患者中不相关，尽管其发生频率相对较高。对反流与每种行为之间时间关系的探究表明，不适、排出、做口型和咳嗽作呕可能引发了反流发作，并且所有这10种行为可能都是由反流发作引起的。这些发现以及6名婴儿在发作前的“安静期”提示了婴儿中有趣的病理生理机制，需要进一步评估。
