中国实用儿科杂志

中国实用儿科杂志

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24小时口咽pH监测诊断儿童咽喉反流价值研究

  

  1. 深圳市儿童医院呼吸科，广东  深圳  518038
  • 出版日期:2017-03-06 发布日期:2017-03-14

Application of 24-hour oropharyngeal pH monitoring in children with suspected laryngopharyngeal re?ux

  1. Department of Respiration， Shenzhen Children’s Hospital，Shenzhen  518038，China
  • Online:2017-03-06 Published:2017-03-14

摘要：

目的    探讨24 h口咽pH监测在呼吸道症状患儿诊断咽喉反流中的应用。方法　采用美国DX－pH检测系统对2015年10月至2016年2月深圳市儿童医院收治的76 例有呼吸道症状疑似咽喉反流患儿进行24 h口咽pH监测并进行临床观察， 观察内容包括检查完成情况、 依照RYAN 指数诊断的阳性率及阳性患儿临床特点。 结果　76例患儿均完成检测；其中阳性30例（阳性率39.5%），较低年龄患儿咽喉反流比例略高于较高年龄者；部分患儿抗酸治疗8周后复查转阴。咽喉反流阳性患儿临床表现为咳嗽、喘息、打鼾、声嘶、清咽、呛奶、吐泡沫、喉鸣、气促、面色发绀、鼻塞等，初步诊断多为支气管肺炎、鼻炎及鼻窦炎、喉软化、咽炎、喘息性支气管炎、腺样体肥大等呼吸道疾病。结论　呼吸道疾病患儿可存在咽喉反流，咽喉反流临床症状无特异性，易误诊漏诊；24 h口咽pH监测操作简便，适用于各年龄段患儿，可作为可疑咽喉反流患儿的检查手段。

关键词: 24 h口咽pH监测, 咽喉反流, 儿童, 诊断

Abstract:

Objective　To explore the application of oropharyngeal pH-monitoring in diagnosis for children with suspected LPR-related respiratory symptoms. Methods　Children suffering from airway-related problems with suspected LPR between October 2015 and February 2016 were included in this descriptive qualitative study. All subjects underwent oropharyngeal 24-hour pH-monitoring. The positive rate of RYAN index，demographic data，distribution of clinical presentation and initial diagnosis among the positive LPR patients were analyzed. Results　The study included 76 subjects with the age range between 1 month and 12 years old with a mean age of 4.9 years old. All patients successfully completed 24-hour of pH recording and the positive rate of RYAN index was 39.5%（30/76），LPR in younger group was higher than that in the older group. Some LPR patients treated with omeprazole reported RYAN index negtive after 8 weeks of follow-ups. LPR-related presentation included chronic cough，wheezing，snore，hoarseness，throat clearing，choking sucking， foaming at the mouth，stridor，shortness of breath， facial cyanosis and nasal obstruction. Meanwhile， those patients were mostly diagnosed with airway diseases，such as pneumonia，sinusitis and rhinitis，laryngomalacia，pharyngitis，asthmatic bronchitis，adenoid hypertrophy，etc. Conclusion　Clinical manifestations of LPR are nonspecific and  may lead to misdiagnosis. Being minimally invasive and easy for operation，oropharyngeal 24-Hour pH-monitoring can be conducted for children at all ages，and may be considered as the standards for diagnosis of pediatric laryngopharyngeal reflux.

Key words: 24h pharyngeal pH-monitoring, laryngopharyngeal re?ux, child；diagnosis