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目的:评价同步动态监测食管pH及胆汁变化的临床意义.方法:应用便携式pH监测仪及胆汁监测仪同步动态监测15例患者的食管24hpH及胆汁变化情况.结果:⑴15例受检者中5例(33.3%)存在病理性胃食管酸反流,9例(60%)存在十二指肠胃食管胆汁反流(DGER),5例病理性胃食管酸反流者100%同时伴有DGER.⑵9例DGER者胆汁反流期间pH均值=5.78±1.00,酸反流(pH<4)时间百分比=8.30±13.78%,碱反流(pH>7)时间百分比=5.78±7.96%.⑶24h总胆汁反流时间百分比与总酸反流时间百分比呈明显的正相关(r=0.925,P<0.001),而与总碱反流时间百分比之间未见明确的相关性(P>0.35).结论:十二指肠-胃-食管胆汁反流,尤其是混合性反流并不少见,十二指肠-胃-食管胆汁反流与胃食管酸反流呈明显正相关,而与碱反流无明显相关性.24hpH监测胃食管反流有一定局限性尤其对混合性反流患者易漏诊.用碱反流来描述十二指肠-胃-食管胆汁反流似乎并不合适.
Objective: To evaluate the clinical significance of synchronously monitoring esophageal pH and bile changes.Methods: The changes of esophageal 24hpH and bile in 15 patients were simultaneously and dynamically monitored by portable pH monitor and bile monitor.Results: Among the 15 subjects (33.3%) had pathologic gastroesophageal reflux, 9 (60%) had duodenogastric gastroesophageal reflux (DGER) and 5 had pathologic gastroesophageal reflux In the cases of DGER, the average value of pH value during the bile reflux was 5.78 ± 1.00, the time of acid reflux (pH <4) = 8.30 ± 13.78% and the time of alkaline reflux (pH> 7) = 5.78 ± 7.96% There was a significant positive correlation between the percentage of total flow time and the percentage of total acid reflux time (r = 0.925, P <0.001), but no significant correlation with total alkalosis time (P> 0.35) .Conclusion: Duodenal - gastric - esophageal bile reflux, especially mixed reflux is not uncommon, duodenum - stomach - esophageal bile reflux and gastroesophageal reflux was positively correlated, and no significant correlation with the base reflux Correlation .24hpH monitoring of gastroesophageal reflux has some limitations, especially for patients with mixed reflux reflux misdiagnosis. Using alkaline reflux to describe the duodenum - stomach - food Bile reflux does not seem appropriate.