Ewer A K, Durbin G M, Morgan M E, Booth I W
Institute of Child Health, University of Birmingham.
Arch Dis Child Fetal Neonatal Ed. 1996 Sep;75(2):F117-21. doi: 10.1136/fn.75.2.f117.
Gastro-oesophageal reflux is common in preterm infants, but the role of gastric emptying as a causal factor has not been studied before. Gastric emptying was therefore measured in 19 healthy preterm infants (median gestational age 32 weeks) while concurrently measuring 24 hour lower oesophageal pH, using an antimony pH electrode, positioned manometrically. Real time ultrasonic images of the gastric antrum were obtained, and measurements of antral cross-sectional area (ACSA) were made immediately before a nasogastric feed and then during subsequent gastric emptying until ACSA returned to its pre-feed value. Half emptying time (50% delta ACSA) was calculated as the time taken for the ACSA to fall to half the maximal postprandial increment. Mean (SEM) reflux index for the group was 11.9 (2.0)%; number of reflux episodes per 24 hours: 15.4 (1.7); and number of reflux episodes longer than five minutes 5.5 (0.8). Average half emptying times for an individual infant were: median (range) 46 (18-105) minutes. There was no association between gastric emptying rates and any of the indices of gastro-oesophageal reflux, either during the entire 24 hour period for which the lower oesophageal pH was recorded, or in the postprandial periods after the feeds which were studied ultrasonically. Gastro-oesophageal reflux was also unrelated to feed volume and feed type. Asymptomatic gastro-oesophageal reflux is common in preterm infants, but gastric emptying time is not a determinant of it. Inappropriate relaxation of the lower oesophageal sphincter or abnormal oesophageal motility offer more plausible explanations.
胃食管反流在早产儿中很常见，但胃排空作为一个致病因素的作用此前尚未得到研究。因此，对19名健康早产儿（中位胎龄32周）进行了胃排空测量，同时使用经测压定位的锑pH电极测量24小时食管下段pH值。获取胃窦的实时超声图像，并在鼻饲前立即测量胃窦横截面积（ACSA），然后在随后的胃排空过程中进行测量，直至ACSA恢复到喂食前的值。半排空时间（50% ACSA变化量）计算为ACSA降至餐后最大增量一半所需的时间。该组的平均（标准误）反流指数为11.9（2.0）%；每24小时反流发作次数：15.4（1.7）；反流发作超过5分钟的次数为5.5（0.8）。单个婴儿的平均半排空时间为：中位数（范围）46（18 - 105）分钟。在记录食管下段pH值的整个24小时期间，或在超声研究的喂食后的餐后期间，胃排空率与任何胃食管反流指标之间均无关联。胃食管反流也与喂食量和喂食类型无关。无症状性胃食管反流在早产儿中很常见，但胃排空时间不是其决定因素。食管下括约肌的不适当松弛或食管运动异常提供了更合理的解释。
