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[目的]观察马来酸曲美布汀对伴有无效食管动力的胃食管反流病患者食管运动功能的影响。[方法]对经内镜、24h食管pH-阻抗监测诊断为胃食管反流病,并行高分辨率食管压力测定(high resolution manometry,HRM),依据芝加哥3.0版标准诊断为无效食管动力的16例患者,给予马来酸曲美布汀0.2g tid、埃索美拉唑20mg、bid治疗2周后复查HRM,比较治疗前后下食管括约肌静息压(LESP)、食管体部各段波幅及时限、吞咽成功率、失蠕动比例、弱蠕动比例以及远端收缩积分(DCI)值等指标的变化。[结果]16例患者治疗前后LESP变化差异无统计学意义(P>0.05),在LESP明显降低的7例患者中,与治疗前相比,治疗后LESP明显增加[(1.8±0.9)mmHg(1mmHg=0.133kPa)∶(8.2±5.4)mmHg],差异有统计学意义(P<0.05);液体吞咽中,食管中段收缩波幅较治疗前明显增加[(33.7±11.4)mmHg∶(42.7±19.9)mmHg)],P<0.05;黏性吞咽中,食管远端收缩波幅较治疗前明显增加[(44.7±18.4)mmHg∶(57.5±23.4)mmHg],P<0.05;液体吞咽时,失蠕动比例较治疗前均显著下降,P<0.05;液体及黏性吞咽时,DCI值均较治疗前明显增加,P<0.05。在液体吞咽时,吞咽成功率较治疗前增加,差异有统计学意义,P<0.05。[结论]马来酸曲美布汀可能增加合并下食管括约肌低压的GERD患者的LESP,通过增加食管体部收缩波幅,改善合并无效食管动力的GERD患者食管体部的廓清功能。
[Objective] To observe the effect of trimebutine maleate on esophageal motility in patients with gastroesophageal reflux disease accompanied by ineffective esophageal motility. [Method] The diagnosis of gastroesophageal reflux disease by endoscopy and 24h-esophageal pH-impedance monitoring was performed in high resolution manometry (HRM). According to Chicago 3.0 version, 16 cases were diagnosed as ineffective esophageal motility Patients were given trimebutine maleate 0.2g tid and esomeprazole 20mg twice daily for HRM. The resting esophageal sphincter pressure (LESP) before and after treatment, the amplitude and duration of esophageal body segments , Swallowing success rate, loss of peristalsis ratio, weak peristalsis ratio and distal systolic integral (DCI) values and other indicators of change. [Results] The changes of LESP in 16 patients before and after treatment showed no significant difference (P> 0.05). Among the 7 patients with significantly decreased LESP, LESP increased significantly after treatment compared with those before treatment [(1.8 ± 0.9) mmHg (8.2 ± 5.4) mmHg], the difference was statistically significant (P <0.05). During the swallowing, the amplitude of contraction in the middle part of the esophagus increased significantly compared with that before treatment [(33.7 ± 11.4) mmHg: (42.7 ± 19.9) ) mmHg)], P <0.05; viscous swallowing, distal esophageal contraction amplitude was significantly increased compared with before treatment [(44.7 ± 18.4) mmHg:57.5 ± 23.4 mmHg], P <0.05; liquid swallowed, P <0.05. The values of DCI in liquid and viscous swallowing were significantly higher than those before treatment (P <0.05). Swallowed in the liquid, the success rate of swallowing than before treatment increased, the difference was statistically significant, P <0.05. [Conclusion] Trimebutine maleate may increase the LESP in patients with GERD combined with lower esophageal sphincter pressure, and improve the esophageal body clearance function of GERD patients with esophageal motility by increasing esophageal systolic amplitude.