医药学论文：胡桃夹子食管患者食管动力与精神心理因素相关性研究-医学论文

  摘 要：目的：探讨胡桃夹食管（nutcracker esophagus NE）与精神心理因素的关系。方法：使用高分辨多道灌注测压系统（PC polrraf HR 瑞典产）分别对20例对照组，两组各15例胡桃夹食管患者钙拮抗剂联用和非联用抗焦虑药物的服药前后不同时段进行食管动力测定。结果：服药前两组NE食管下段蠕动波幅，食管收缩时间，食管体部运动异常检出率三项指标均高于对照组，服药后30天两组NE患者与用药前比较，三项指标测定均有显著性差异（P< 0.01）。用药15d联用抗焦虑药物组的三项指标改善明显优于不联用抗焦虑药物组（P< 0.01）。服药后NE组食管下段蠕动波幅、食管收缩时间和食管体部运动异常检出率与对照组比差异无显著性（P＞0.05）。结论：食管下段高幅蠕动、收缩时间延长在NE发病中起重要作用，精神和心理因素是重要致病因素。治疗中不可缺少联用抗焦虑药物。

　　关键词： 胡桃夹食管； 食管测压； 精神心理因素

　　The Relative study of Esophagus Kinetic and Psychological Factor on Nutcracker Esophagus Patients

　　Abstract： Objective： To explore the relationship between nutcracker esophagus(NE) and psychological factors.Method： The esophagus kinetic in different time was determined by using the polygraf HR manometry examination system exophageal manometry(PC polrraf HR,manufactured by Sweden)in 50 patients with nutcracker esophagus.20 cases belonged to control group.15 cases were treated with calcium antagonist and anti-anxiety drugs. 15 cases were only treated with calcium antagonist. Results： Before taking the medicine,the positive rate of esophagus inferior segment peristalsis amplitude,esophagus peristalsis duration and esophagus body department motile abnormality in the two groups was obviously higher than that in control group. 30 days after taking the medicine, the medicine, the three parameters were existed significant differences in the two group NE patients(P< 0.01). 15 days after taking the medicine, the three parameters.In the patients treated with calcium antagonist and anti-anxiety drugs were obviously better than that in the patients treated only with calcium antagonist(P< 0.01).After taking the medicine,the positive rate of the three parameters in NE group was not significant when compared with control group(P>0.05).Conclusion： Esophagus motile function disorder,inferior segment peristalsis amplitude and peristalsis duration played an important role on the NE episode.Psychological factor was important inducing factor.Anti-anxiety drugs should be used in the treatment.

　　Key words： Nutcracker esophagus; Esophagus pressure detection; Psychological factor

　　胡桃夹食管（NE）是一种原发性食管运动障碍性疾病，为了解NE的食管在使用不同性质药物治疗后的动力学改变特征，进而探讨其发病机理，我们将NE患者分为两组，分别应用抗焦虑药物和不应用抗焦虑药物治疗，观察食管压力变化，探讨如下：

　　1 材料与方法

　　1.1 研究对象

　　1.1.1 对照组20例，其中男8例，女12例，年龄29～58岁，平均年龄，38±7.2岁。入选条件：临床无食管疾病及胃食管反流病，无累及食管的全身性疾病，无胃肠手术史。

　　1.1.2 NE组 ，30例，男11例，女19例，年龄在28～62岁，平均年龄39±12岁。主要症状为胸痛，其中8例有吞咽困难，排除心血管疾病和胃肠器质性疾病，食管钡餐和食管动力测压排除贲门失弛缓症。随机分为两组，每组各15人。

　　1．2 方法
1.2.1 对照组和NE组检查前停用胃肠动力药1周，禁食12h，行食管测压。

　　1.2.2 NE组一，分别在服用15d和30d钙通道阻断剂硝苯吡啶、消心痛和抗焦虑药阿普唑仑行食管测压。

　　1.2.3 NE组二，分别在服用15d和30d钙通道阻断剂硝苯吡啶、消心痛行食管测压。