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目的研究伊托必利对伴有食管运动障碍的非糜烂性反流病(NERD)患者症状及不同吞咽模式下食管运动功能的影响。方法按标准选取具有典型胃食管反流症状及食管运动障碍的NERD患者34例,评估其胃食管反流症状,行不同物理性质食团(10次5 ml液体、10次胶体吞咽、10次2×2×2 cm固体吞咽)下高分辨率食管测压,给予伊托必利50 mg tid,对比2周治疗前后胃食管反流症状改善情况和各种吞咽模式下食管动力的改变。结果 (1)与治疗前相比,伊托必利可降低胃食管反流各单项症状及总症状积分(32.1±10.3 vs 8.2±2.9,P=0.000)。(2)降低NERD患者下食管括约肌(LES)压力的异常率(64.7%vs 29.4%,P=0.004),显著提高LES低下患者的压力值(5.4±2.6 mmHg vs 9.2±4.4 mmHg,P=0.003)。(3)增加不同食团吞咽时食管近、中、远段压力及远段食管收缩积分(P值均<0.05),对波峰起始速度、收缩前沿速度无明显影响(P值均>0.05)。(4)提高不同食团吞咽时的吞咽成功率,降低体部运动功能障碍数(P值均<0.05)。结论伊托必利可有效改善NERD患者的胃食管反流症状,部分改善食管运动障碍,对不同吞咽模式的动力影响有不同。
Objective To investigate the effects of itopride on the symptoms of esophageal motility and esophageal motility in patients with non-erosive reflux disease (NERD) accompanied by esophageal dyskinesia. Methods According to the standard, 34 patients with typical gastroesophageal reflux symptoms and esophageal dyskinesia were enrolled in this study. The gastroesophageal reflux symptoms were evaluated. The diet of different physical properties (10 ml of 5 ml liquid, 10 times of colloid swallowing, 10 times 2 × 2 × 2 cm solid swallowing) under high-resolution esophageal manometry, given itopril 50 mg tid, compared to two weeks before and after treatment to improve gastroesophageal reflux symptoms and various swallowing modes esophageal motility changes. Results (1) Itopride could reduce individual symptoms and total symptom scores of gastroesophageal reflux (32.1 ± 10.3 vs 8.2 ± 2.9, P = 0.000) compared with before treatment. (2) The abnormal rate of lower esophageal sphincter pressure (64.7% vs 29.4%, P = 0.004) in patients with NERD decreased significantly (5.4 ± 2.6 mmHg vs 9.2 ± 4.4 mmHg, P = 0.003 ). (3) Increasing esophageal proximal, mid-distal pressure and distal esophageal systolic scores (P <0.05) when swallowing different boluses had no significant effect on the initial peak wave velocity and contracting front velocity (P> 0.05) . (4) to improve the swallowing success rate of different groups of swallowing, reduce the number of motor dysfunction (P <0.05). Conclusion Itopride can effectively improve the symptoms of gastroesophageal reflux disease in patients with NERD, and partially improve esophageal dyskinesia, with different effects on the dynamic of different swallowing modes.