咽喷嘴及3S现象:胃食管气道反流的实验研究

摘要

Objective To investigate the relationship between esophageal reflux and airway disorders by establishing animal model of esophageal reflux. Methods ①Experiment 1: 2 Sprague Dawley (SD) rats were used as study group and 2 as control group. Rats in study group was used as esophageal reflux model, the pylorus was ligated, and 1 nd of methylene blue was injected into the stomach in both groups. ②Experiment 2: 3 SD rats were enrolled for establishing upper esophageal reflulx model, 10％ glucose normal saline was injected reversely from lower esophagus to observe the pahryx. ③Experiment 3:3 SD rats were used, and the method was the same as experiment 2, except the glucose normal saline was replaced by meglumine diatrizoate, and the study was carried out under observation of X-ray. ④Experiment 4:2 white rabbits were selected to replace the SD rats, the rest was the same as Expriment 3. ⑤Experiement 5: Another 2 white rabbits were treated as Experiment 4,except the meglumine diatrizoate was replaced by 10 ％ barium sulfate suspention. Results In Experiment 1, both esophagus and trachea were blue-stained in the study group, only esophagus was filled with blue in the control group. In Experiment 2,the experimental water spilled out from pharynges first, and then sprayed out at different angle and various levels. In Experiment 3, a beak like pharyx, or pharyngeal nozzle, was found under X-ray, while the medial contrast went reversely. In Experiment 4, the medial contrast sprayed from pharyngeal nozzle to the oral and nasal cavities,larynx and trachea. In Experiment 5,a pharyngeal nozzle and a trans-nozzle spraying identified, barium mist was found in the larynx ,trachea,and even lung. Conclusion The experimental study has confirmed our clinical hypothesis of esophago-airway reflux, that irritates the upper lower airway with larygopharyx as center, and also discloses a phenomenon of "pharyngeal nozzle" and its "3S" mechanism consisting of spilling, spraying and spurting,which provides evidence for further study of the disease.%目的 通过动物实验建立食管反流模型探讨食管反流与呼吸道疾病的关系.方法 ①实验1:将4只SD大鼠分别设为实验和对照组.实验组制成食管反流模型,两组均在结扎封闭肠腔,向胃腔注入亚甲蓝1 ml.②实验2:将3只SD大鼠制成食管高位反流模型,食管内加压注入10%葡萄糖氯化钠注射液观察咽部反流表现.③实验3:将3只SD大鼠制成食管高位反流模型,加压注射泛影葡胺造影剂,在X线下动态观察咽部反流表现.④实验4:将大耳白兔2只制成食管高位反流模型,加压注射泛影葡胺造影剂,在X线下动态观察咽部反流表现.⑤实验5:大耳白兔2只, 以10%硫酸钡混悬液替代泛影葡胺,余同实验4.结果 实验1中,实验组大鼠食管充满蓝色,气道有不同程度蓝染;对照组仅部分食管蓝染.实验2中,随着反流启动压力的增加,可见实验用水从大鼠咽部向上溢出,喷洒在不同平面,喷入喉腔时见到气管收缩.实验3中,X线下观察造影剂形成反流时咽部呈喷嘴,并见向咽上喷洒和少量造影剂进入气管.实验4中,X线下观察反流在咽部呈喷嘴,并经此喷射入口、鼻和咽喉,喉和气管内见少量造影剂;反流压力增高时,更多造影剂喷出.实验5中X线下见到明显的咽部鸟嘴、经咽喷洒和雾状物进入喉腔、气管甚至到达肺部.结论 实验证实了研究者的临床假设:由胃食管气道反流激惹了以咽喉为中心的上呼吸道和下呼吸道,并证实食管反流状态下的咽喷嘴及其由溢出、喷洒和喷出(spilling、spraying、spurting)组成的3S现象,为探讨胃食管气道反流所致呼吸道疾病的发病机制提供了依据.