目的 探讨食管阻抗-pH监测技术在鼻胃管管饲高龄患者中的应用价值。方法 选取2021-11至2022-04解放军总医院第二医学中心胃肠功能室行24 h食管阻抗-pH监测的高龄患者35例,按进食方式分为胃管管饲组(n=19)和经口摄食组(n=16),采用队列研究的方法比较各监测指标上的差异,总结鼻胃管管饲高龄老年人的反流特征。结果 胃管管饲组与经口摄食组反流物性质占比存在差异(P＜0.05),胃管管饲组液体反流比例较高,经口摄食组气体反流较多。反流高度上,胃管管饲组近端反流百分比明显高于经口摄食组[83.70%(71.20%～93.80%) vs 62.85%(37.83%～76.78%),P＜0.05]。酸相关参数(酸反流时间、酸反流次数,酸暴露时间百分比、长反流次数、最长反流时间、餐后酸暴露时间百分比)比较无统计学差异。结论 鼻胃管管饲高龄患者胃食管反流的类型以液体反流为主,食管阻抗-pH监测对该人群的反流评估、精准用药、肠内营养支持策略的制定具有指导意义。
Abstract
Objective To explore the clinical Value of esophageal multichannel intraluminal impedance-pH(MII-pH) monitoring in the elderly with nasogastric tube feeding. Methods Thirty-five elderly patients were divided into gastric tube feeding group (n=19) and oral feeding group (n=16) according to the feeding mode who underwent esophageal MII-pH 24 hours monitoring in the Gastrointestinal function Unit of the Second Medical Center of PLA General Hospital from November 2021 to April 2022. DeMeester score, pathological reflux and other monitoring index were compared between the two groups to summarize the reflux characteristics of the elderly fed by nasogastric tube. Results In the gastric tube group, the proportion of liquid reflux and percentage of proximal reflux were higher than those of oral group, 83.70%(71.20%, 93.80%) vs. 62.85%(37.83%, 76.78%) and the differences were statistically significant (Z=-4.537, -2.914, P<0.05). There were no significant differences in the acid reflux time, number of acid reflux, AET, number of long reflux, longest reflux time and AET of 2 h postprandial between the two groups. Conclusions Liquid reflux is the main type of gastroesophageal reflux in elderly patients with tube feeding. Esophageal MII-pH monitoring is of great significance for reflux evaluation, precision medicine and formulation of enteral nutrition support strategy in this population.
关键词
胃管 /
高龄 /
食管pH-阻抗监测 /
胃食管反流 /
肠内营养
Key words
gastric tube /
advanced age /
multichannel intraluminal impedance–pH (MII-pH)/esophageal monitoring /
gastroesophageal reflux /
enteral nutrition
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基金
军队护理创新与培育专项计划培育项目(2021HL083)
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