為什么要用阻抗-EFT課件

5-06-08?2008阻抗-壓力技術基本知識丁文京博士北美醫(yī)學基金會E-mail:abs94555@5-06-08?2008食管聯(lián)合阻抗-壓力測量技術在吞咽障礙中的應用

丁文京博士E-mail:abs94555@提要為什么要用聯(lián)合阻抗-壓力測量技術？阻抗技術原理阻抗測量的是什么聯(lián)合阻抗-壓力測量的是什么系統(tǒng)構成應用案例HRiM聯(lián)合兩種監(jiān)測ProbeSpecificationsChannels:32Pressure/6impedanceDiameter:12French/4mm阻抗電極評估食團傳輸壓力電極評估收縮性阻抗測量的是什么：食團的運動聯(lián)合阻抗-壓力了解食管動力：真實反映食管動力與吞咽的關系。阻抗測量對于研究食管的傳輸功能等同于X線吞鋇的食團傳輸結果。可以動態(tài)連續(xù)記錄分析。

食團完整的傳輸過程20cm15cm10cm5cm食團進入@20cm食團離開@15cm食團離開@10cm食團離開@5cm為什么要測定食團的傳輸？壓力監(jiān)測無法預測或評估食團的傳輸食管壓力異常的患者可能食團傳輸正常食管壓力正常的患者可能食團傳輸存在異常對非梗阻性吞咽困難、打嗝和食管清除功能障礙診斷有重要意義?？梢詤^(qū)分氣體傳輸?shù)姆较?。對每一次吞咽都進行評估，分成食團完全傳輸 食團不完全傳輸吞咽困難病人的食團傳輸ImpedanceDetectedAbnormalBolusTransitinPatientswithNormalEsophagealManometry.SensitiveIndicatorofEsophagealFunctionalAbnormality?;Koyaetal;DiseasesoftheEsophagus(2008)21,563–569吞咽困難N=51食道壓正常N=576食團傳輸正常食團傳輸異常73%27%29%71%DysphagiaPatientsHaveSignificantlyHigherAbnormalBolusTransitMultiChannelIntraluminalImpedanceforTheAssessmentofPost-fundoplicationDysphagia;Yigit,,Quiroga&Oelschlager;UniversityofWashington;DiseasesoftheEsophagus(2006)19,382-388.NormalManometry83%AbnormalManometry17%NormalManometry86%AbnormalManometry14%吞咽困難診斷DysphagiaNoDysphagiaNormalBolusTransit38%AbnormalBolusTransit62%NormalBolusTransit68%AbnormalBolusTransit32%有吞咽困難無吞咽困難食團傳輸正常食團傳輸正常食團傳輸異常食團傳輸異常BolusTransit(Impedance)IncompletebolustransitManometryCompletebolustransitnormal92%ineffective5%simultaneous3%47%53%92%8%97%3%EsophagealFunctionTestingWithCombinedMultiChannelIntraluminalImpedance&Manometry.MulticenterStudyinHealthyVolunteers.R.Tutuianetal;ClinicalGastroenterologyandHepatology;May2003,182430例液體吞咽430例膠凍吞咽ManometryBolusTransit(Impedance)CompletebolustransitIncompletebolustransitnormal92%ineffective5%simultaneous3%35%65%55%45%96%4%EsophagealFunctionTestingWithCombinedMultiChannelIntraluminalImpedance&Manometry.MulticenterStudyinHealthyVolunteers.R.Tutuianetal;ClinicalGastroenterologyandHepatology;May2003,182Standardesophagealmanometrictestingevaluatesswallowinginthesupinepositionusingsmallboluses,witharecoveryperiodimposedbetweenswallows.Manometrictestsofmorephysiologicunrestrictedswallowinghavehadlimitedpracticalapplicationduetohighlyvariableresults.Manometricresultswithlimitedvariabilityincludedthenumberofperistalticsequences,meantimebetweenthesesequencesandtheirdistalesophagealamplitudes.

J.A.Wilson,等人Multichannelintraluminalimpedanceandesophagealmanometrydataforunrestrictedswallowing:establishingnormalvalues，DiseasesoftheEsophagus，Volume21Issue1,

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56聯(lián)合食管阻抗-壓力測量技術的臨床意義

檢測食團傳輸模式和方向計算食團傳輸?shù)母鞣N參數(shù)評估食團排空檢測與食團運動相關的事件了解食團傳輸和LES放松的關系獲得食管動力學生理和病生理的詳細信息非梗阻性吞咽障礙患者的食管運動功能分類精確定義食管運動功能精確定義正常和異常胃底折抵術適應癥原則和效果評估指導治療方案和評估治療效果其它聯(lián)合食管阻抗-壓力Oesophagealmanometryusedtobeconsideredthe"goldstandard"testfortheevaluationofoesophagealmotility.Impedancecombinedwithtraditionalmanometryinonetestprovidesadditionalinformationaboutesophagealtransit.ThiscombinationoftestsprovidesinformationpreviouslyonlyavailablewhencombiningmanometrytestingwithBariumswallowstudies.ThisiscalledthefirstcompleteEsophagealFunctionTest(EFT).

DavidA.Johnson,MD，PublishedinJournalWatchGastroenterologyApril27,2004,CoveringClin

Gastroenterol

Hepatol2004Mar;2:230-6Combinedimpedance-manometrytestingofferstheopportunitytoquantifyesophagealbolustransitandclarifiestheimplicationsofesophagealmotilityabnormalitiesonesophagealfunction.Thisisofparticularinterestinpatientswithnon-obstructivedysphagiaandinpatientswithpost-fundoplicationdysphagia.Combinedimpedance-pHmonitoringallowsthedetectionofgastroesophagealrefluxepisodesindependentofpH.Thisisofparticularimportancewhenevaluatingpatientswithpersistentsymptomsonacidsuppressivetherapy.TheabilitytodetectgastroesophagealrefluxepisodeswithpH>4unfoldsnewquestionsontheoptimalapproachtopatientswithsymptomaticnon-acidreflux.CONCLUSIONS:

Impedancetechnologyallowsthedetectionoffluidmovementsintheesophagus.

R.

Tutuian，Impedancetechnologyforthemanagementofesophagealdisorders.EuropeanSurgery,Volume40,p.50-57食管功能檢測記錄聯(lián)合阻抗和壓力：阻抗反應食團傳輸情況；壓力反應食管肌肉收縮功能?？梢苑治鲆簯B(tài)、膠凍、濕食團、干食團、固態(tài)、離子化固態(tài)等多種類型吞咽?？梢詫崟r分析食團在每個通道的進出時間，食團通過時間，食團完全傳輸時間，自動判斷是否完全傳輸和不完全傳輸?shù)脑?，精度達到毫秒。自動分析：上/下食管括約肌壓力、食管收縮協(xié)同性、是否完全傳輸、括約肌長度、括約肌收縮壓和靜息壓。常用食管功能檢測內(nèi)容包括平均值、中值等在內(nèi)的多種計算方式，并且在現(xiàn)實實際測量結果的同時提供正常值的顯示。分別設置不同食物不同位點的正常值，可單獨復位，也可全部同時復位?；€，pH區(qū)域，LES以上，起始點，位置，多通道阻抗，高度，p