数字化音乐胃电起搏对难治性胃食管反流病患者临床症状、焦虑抑郁状态和食管动力学的影响

摘要

背景：胃食管反流病（GERD）为消化系统常见疾病之一，部分患者对常规4~8周质子泵抑制剂治疗反应不佳。目的：观察数字化音乐胃电起搏对难治性 GERD 患者临床症状、焦虑抑郁状态和食管动力学的影响。方法：选取2014年1月—2015年10月在第三军医大学第三附属医院就诊的难治性 GERD 患者53例，诊断符合 GERD 蒙特利尔全球共识定义。予患者数字化音乐胃电起搏治疗15 d，治疗前后行临床症状评分、汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评分以及食管动力学特征评估。结果：经治疗15 d 后，患者烧心、反酸（昼）、反酸（夜）、上腹痛、恶心、睡眠障碍症状评分均较治疗前显著降低（P <0.001）。治疗前多数患者伴有焦虑抑郁，治疗后HAMA、MAMD 评分均显著降低（P <0.001）。与治疗前相比，治疗后患者下食管括约肌静息压（ LESP）、食管远端波波幅、蠕动波持续时间、蠕动波起始速度、远端收缩积分均显著增高（P <0.05）。结论：数字化音乐胃电起搏对难治性 GERD 有良好的疗效，可提高 LESP，改善食管体部运动功能，并缓解患者的临床症状和焦虑抑郁状态，可能成为食管动力障碍性疾病非药物治疗的新选择。%Background:Gastroesophageal reflux disease(GERD)is a common disorder of digestive system,however,some of patients are not responding to conventional 4-8 weeks proton pump inhibitor therapy. Aims:To investigate the effect of digital music gastric electrical pacing on clinical symptoms,anxiety and depression and esophageal motility in patients with refractory GERD. Methods:Fifty-three patients with refractory GERD from Jan. 2014 to Oct. 2015 at the Third Affiliated Hospital,the Third Military Medical University were recruited. All of them fulfilled the Montreal definition of GERD. Digital music gastric electrical pacing was performed for 15 days and the efficacy was evaluated by clinical symptom scoring,Hamilton anxiety scale( HAMA),Hamilton depression scale( HAMD)and esophageal motility manometry. Results:After 15-day treatment,the main symptoms,including heartburn,daytime and nocturnal acid reflux,upper abdominal pain,nausea,and sleep disorder were significantly improved(P < 0. 001). A great proportion of patients were complicated with anxiety and/ or depression at recruitment,and after treatment the scores of HAMA and HAMD were decreased significantly(P < 0. 001). Meanwhile,the lower esophageal sphincter resting pressure(LESP),distal wave amplitude,peristaltic wave duration,speed of peristaltic wave and distal contraction integral after treatment were significantly increased as compared with the baseline values(P < 0. 05). Conclusions:Digital music gastric electrical pacing is effective for treatment of refractory GERD with increase of LESP and esophageal body motility. The clinical symptoms and anxiety and depression are improved simultaneously. Digital music gastric electrical pacing is expected to be a new choice of non-medicine treatment for esophageal motility disorders.