摘要目的 应用高分辨率食管测压分析不同食团对非梗阻性食管源性吞咽困难患者食管动力的影响.方法 纳入2014年3月至2015年6月就诊的48例非梗阻性食管源性吞咽困难患者和12名健康志愿者(健康对照组),进行液体吞咽、黏胶吞咽、固体吞咽的高分辨率食管测压检查,分析食管下括约肌压力(LESP)、4 s完整松弛压(4 s IRP)、远端收缩积分(DCI)、远端潜伏期(DL)和收缩中断等指标.统计学方法采用t检验.结果 根据2014芝加哥分类标准,48例吞咽困难患者中,食管动力异常者35例(72.9％),其中最常见的食管动力障碍类型是无效食管动力[31.2％ (15/48)];食管动力功能完全正常者13例(27.1％).健康对照组LESP为(10.85±3.75)mmHg(1 mmHg=0.133 kPa),4 sIRP为(1.90±0.84) mmHg;吞咽困难组LESP为(12.20±8.93) mmHg,4 sIRP为(3.25±1.02) mmHg;两组LESP、4 s IRP比较差异均无统计学意义(P均＞0.05).健康对照组液体吞咽、黏胶吞咽和固体吞咽的DCI分别为(589.00±292.90)、(690.17±52.41)和(808.00±448.53) mmHg·s·cm,分别低于芝加哥分类完全正常组的(1 346.62±244.83)、(1 542.46±231.19)和(1 890.31±363.26) mmHg·s·cm,差异均有统计学意义(t=4.76、4.68、3.79,均P=0.001);健康对照组固体吞咽DL为(7.72±1.15)s,低于芝加哥分类完全正常组的(9.00±1.23)s,差异有统计学意义(t=2.61,P=0.021);健康对照组液体吞咽、黏胶吞咽和固体吞咽的收缩中断分别为(2.33±1.74)、(2.37±1.72)和(1.53±1.22) cm,分别高于芝加哥分类完全正常组的(0.58±0.48)、(0.52±0.47)和(0.85±0.53) cm,差异均有统计学意义(t=3.02、3.68、2.54,P均＜0.05).结论 非梗阻性食管源性吞咽困难患者最常见的食管动力障碍类型是无效食管动力;有吞咽困难症状但芝加哥分类却完全正常的患者,其吞咽食物时食管需用更大的力量、更完整的收缩和更长的蠕动时间才能将其向下推进.

abstractsObjective To analyze the effects of different food bolus on esophageal motility in patients with non-obstructive esophageal dyshagia by high-resolution esophageal manometry.Methods From March 2014 to June 2015,48 patients with non-obstructive esophageal dysphagia and 12 healthy volunteers (healthy control group) were enrolled.High-resolution manometry was tested when swallowing liquid food,semisolid food and solid food.The lower esophageal sphincter pressure (LESP),4 second integrated relaxation pressure (4 s IRP),distal contractile integral (DCI),distal latency (DL),and breaks were analyzed.T test was performed for statistical analysis.Results According to the 2014 Chicago classification standard,among 48 patients with dysphagia,esophageal dysmotility was diagnosed in 35 patients (72.9％),while 13 patients (27.1％) had normal esophageal motility,and the most common type of esophageal motility disorder was ineffective esophageal motility (31.2％,15/48).The LESP of the healthy control group was (10.85±3.75) mmHg (1 mmHg=0.133 kPa) and 4 s IRP was (1.90±0.84) mmHg.The LESP of dysphagia group was (12.20 ±8.93) mmHg and 4 s IRP was (3.25± 1.02) mmHg.There was no significant difference in LESP and 4 s IRP between two groups (both P＞0.05).The DCIs of liq(u)id swallows,semisolid swallows and solid swallows of healthy control group were (589.00±292.90),(690.17±52.41) and (808.00±448.53) mmHg · s · cm,respectively,which were significantly lower than those of complete normal group in Chicago classification ((1 346.62 ± 244.83),(1 542.46±231.19) and (1 890.31±363.26) mmHg · s · cm;t=4.76,4.68 and 3.79;all P=0.001).The DL of solid swallows of healthy control group was (7.72± 1.15) s,which was significantly lower than that of complete normal group in Chicago classification ((9.00±1.23) s;t=2.61,P=0.021).The breaks of liquid swallows,semisolid swallows and solid swallows of healthy control group were (2.33 ±1.74),(2.37±1.72) and (1.53± 1.22) cm,respectively,which were higher than those of complete normal group in Chicago classification ((0.58±0.48),(0.52±0.47) and (0.85±0.53) cm),and the differences were statistically significant (t =3.02,3.68 and 2.54,all P ＜ 0.05).Conclusions The most common type of esophageal motility disorder in patients with non-obstructive esophageal dysphagia is ineffective esophageal molitity.When swallowing food,the patients with dysphagia but normal results of esophageal manometry according to Chicago classification require more strength of the esophagus,more complete contraction and longer peristaltic time to swallow food bolus.