Eid N S, Shepherd R W, Thomson M A
Kosair Children's Hospital, Department of Pediatrics, School of Medicine, University of Louisville, Kentucky.
Pediatr Pulmonol. 1994 Jul;18(1):39-44. doi: 10.1002/ppul.1950180110.
We have evaluated the presence of gastroesophageal reflux (GER) and the effect of its treatment in 12 infants (mean age, 7 months; range, 4-11 months) with persistent wheezing not responding to bronchodilators and anti-inflammatory asthma medications. All patients had GER on cineradiography and significant acid reflux on 24 hour pH monitoring (percentage of time pH < 4 ranged from 6.1 to 47%). All infants were initially treated with prokinetic agents and with receptor histamine antagonists in addition to aggressive pulmonary therapy. Six patients treated medically had substantially decreased use of asthma medications, completely discontinuing them within 2-4 months. Two patients, though significantly improved, require intermittent asthma therapy. Four patients responding poorly to GER and asthma treatment for 2 months to 2 years had fundoplications. These had an excellent outcome over 1-4.5 years follow-up; only one patient required further asthma medications. Pulmonary function testing was done in six patients before and after 6-8 weeks of therapy indicating significant improvement in peripheral airflow: terminal flow/peak tidal expiratory flow (TEF25/PTEF), and percentage of total expiratory time to reach peak tidal expiratory flow (Tp/Te or Tme/Te). Our experience suggests that evaluation for GER should be considered in infants with persistent wheezing. Aggressive medical and possibly surgical therapy for GER may resolve persistent wheezing.
我们评估了12名患有持续性喘息且对支气管扩张剂和抗炎性哮喘药物无反应的婴儿（平均年龄7个月；范围4 - 11个月）胃食管反流（GER）的存在情况及其治疗效果。所有患者在食管动态造影检查中均存在GER，且在24小时pH监测中有明显的酸反流（pH < 4的时间百分比范围为6.1%至47%）。所有婴儿最初除了积极的肺部治疗外，还接受了促动力剂和组胺受体拮抗剂治疗。6名接受药物治疗的患者哮喘药物使用量大幅减少，并在2 - 4个月内完全停用。2名患者虽有显著改善，但仍需要间歇性哮喘治疗。4名对GER和哮喘治疗反应不佳达2个月至2年的患者接受了胃底折叠术。在1 - 4.5年的随访中，这些患者预后良好；只有1名患者需要进一步使用哮喘药物。6名患者在治疗6 - 8周前后进行了肺功能测试，结果表明外周气流有显著改善：终末流速/潮气量峰值呼气流量（TEF25/PTEF），以及达到潮气量峰值呼气流量的总呼气时间百分比（Tp/Te或Tme/Te）。我们的经验表明，对于患有持续性喘息的婴儿应考虑评估GER。对GER进行积极的药物治疗以及可能的手术治疗可能会缓解持续性喘息。
