胃pH监测对残胃黏膜泌酸功能的应用价值.pdfVIP

层医药2007年 11月第14卷第 1l期 Chin J Prim Med Pham~，NoverI1b!1 2 1， ． ， ． · 1785 · 胃pH监测对残胃黏膜泌酸功能的 应用价值 应 力 朱庆华 姜 铀 姜春萌 【摘要】 目的 研究胃远端部分切除术后患者泌酸功能及其与黏膜病理改变、胆汁反流和幽门螺杆菌 (Hp)感染的相关性 方法 采用24 h pH监测仪测定51例残胃患者空腹胃内pH值，根据24 h胃内平均pH 值分为低泌酸组(pH≥3)和正常泌酸组(pH3)。胃镜观察残胃黏膜以及 Hp检测。结果 低泌酸组患者35 例，其中29例黏膜呈重度萎缩；正常泌酸组 16例，其中4例呈重度黏膜炎症(P：0．0061。胆汁反流率在低 泌酸组和正常泌酸组分别为37．4％和18、7％(P=0．014)。两组间Hp感染率差异无统计学意义。62．7％的 患者胃酸分泌减少．但却接受了抑酸药物药物治疗。结论 24 h动态胃pH监测可有效评价残胃患者胃黏膜 泌酸功能。胆汁反流和残胃炎程度与黏膜泌酸功能有明显相关性。 【关键词】 氢离子浓度；胃酸；胃残端；幽门螺杆菌 Clinical research of acid secreting function in patients with gastric stump YING Li，ZHU Qing-hua．JIANG yf】 JIANG aⅢ ,llelZg．Depa~ f M?，of Gastroenterolog5，．roHd A 7liated Hospital，Dalian Medical Univet‘si— t3，．Dalian，Liaoning 1 1 6023，Chino 【Abstract】 Ohjecti~re To investigate acid—secreting functional status of gastric stump and the clinical signifi— cance．Methods pH valuc of gastric stump in 24 hours＼Vel-C monitored Gastric mueosa was observed by endoscopy and biops3，．He icobacter P3 lori were examined．Results 35 patients with partial gastrectomy showed pH≥3 in 24 hours，including 29 with atrophic gastritis．16 showed pH3，including 4 with severe gastritis．The ratio of bile re· flux in patients with 24一hour—pH mean value≥3 and3 were 37 4％and 18．7％，respectively There was Do sig— nificant difference b(~wee1]the two groups．About 62 7％ patients which had no or little capability to produce acid received acid suppressing therapy．Conclusions 24h pH monitoring was an efficient method tO detect mucous acid secreting function in patients with gastric stump．The presence of bile reflux and the degree of gastritis correlated with acid secretion of inucosa 【Key words】Hydrogen—Ion concentration；Gastric acid；Gastric stump；Helicobaeter pylori 胃远端部分切除术，曾是解决胃溃疡等多种良 表1 残胃患者的临床资料 性疾病的重要手段。尽管近年来有效的药物治疗已 经逐渐取代了手术治疗，临床上仍常见胃远端部分 切除术后的患者。文献关于残胃胃酸分泌的报道不 一 致。部分观点认为20～25年几乎全部的残胃黏 膜会发生萎缩和胃酸分泌缺乏…，另外报道认为不 是所有的残胃黏膜都发展成