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目的探讨膈肌生物反馈训练加强GERD患者胃食管交界处(EGJ)抗反流屏障作用。方法80例GERD患者随机分为PPI组和PPI联合膈肌生物反馈训练组,每组分别入选40例,疗程为8周。PPI组(雷贝拉唑10 mg Bid)。反馈+PPI组在应用PPI治疗同时进行膈肌生物反馈训练(2次/d,15~20 min/次,雷贝拉唑10 mg Bid)。反馈+PPI组患者每周1次到医院在医生指导下进行反馈训练,训练时需空腹。疗程结束后再次评价反流症状、食管动力和内镜下反流性食管炎改善情况。结果(1)治疗8周后,反馈+PPI组反流症状积分由治疗前(10.5±5.3)下降至(6.0±3.7),PPI组由治疗前(10.8±4.7)下降至(7.5±3.2);(2)反馈+PPI组生活质量(GERD-HRQL)积分由治疗前(21.77±6.30)下降至(13.60±7.538),PPI组由治疗前(20.42±6.31)下降至(13.86±7.538);(3)反馈+PPI组较PPI组自主神经受累改善率提高35%;(4)反馈+PPI组与PPI组治疗前后Zung氏焦虑和抑郁自评量表评分比较差异无统计学意义(P>0.05);(5)动力学复查,除膈脚张力显著增加外,LES压力、EGJ压力及食管远端蠕动收缩波幅训练前后差异均无统计学意义。结论膈肌生物反馈训练能显著改善反流症状,减少GERD患者对抑酸药物依赖性;增加GERD患者膈脚的张力,从而增强胃食管交界处的抗反流屏障作用。
Objective To investigate the effect of diaphragm biofeedback training on anti-reflux barrier of gastroesophageal junction (EGJ) in GERD patients. Methods Eighty patients with GERD were randomly divided into PPI group and PPI combined with diaphragm biofeedback training group. Each group was enrolled in 40 cases for 8 weeks. PPI group (rabeprazole 10 mg Bid). In the feedback + PPI group, diaphragmatic biofeedback training (2 times / d, 15-20 minutes / time, rabeprazole 10 mg Bid) was performed while applying PPI. Feedback + PPI group patients once a week to the hospital under the guidance of a doctor feedback training, training required fasting. Reflux symptoms, esophageal motility, and endoscopic reflux esophagitis were evaluated again after treatment. Results (1) After 8 weeks of treatment, the score of reflux symptom in feedback + PPI group decreased from (10.5 ± 5.3) to (6.0 ± 3.7) and PPI decreased from (10.8 ± 4.7) to (7.5 ± 3.2) ; (2) The score of GERD-HRQL decreased from (21.77 ± 6.30) to (13.60 ± 7.538) before treatment and from (20.42 ± 6.31) to (13.86 ± 7.538) before treatment in PPI group; (3) The improvement rate of autonomic nerve involvement in feedback plus PPI group was 35% higher than PPI group; (4) There was no significant difference in Zung’s anxiety and depression self-rating scale before and after feedback + PPI group and PPI group (P> 0.05). (5) Kinetic examination showed no significant difference in LES pressure, EGJ pressure and distal esophageal peristalsis contractility amplitude before and after training. Conclusion Diaphragmatic biofeedback training can significantly improve the reflux symptoms, reduce the dependence on acid-suppressing drugs in GERD patients, increase diaphragmatic tension in GERD patients and enhance the anti-reflux barrier at the gastroesophageal junction.