目的

分析侧卧位与仰卧位高分辨率食管测压（HREM）结果的异同。

方法

选择2019年11 月至2022 年12 月因烧心、反酸、胸痛、反食等症状，在北京市宣武中医医院脾胃病科就诊的胃食管反流病（GERD）患者137 例。所有患者先采用侧卧位检测HREM，之后采用平卧位检测HREM，之后分析两种体位HREM 结果的异同。

结果

受检患者侧卧位时食管上括约肌（UES）残余压平均值显著低于平卧位测量值（P＜0.05），但UES 静息压和压力峰平均值差异无统计学意义（P＞0.05）。侧卧位时食管体部波峰平均值与食管体部蠕动起始速度明显低于平卧位（P＜0.001），两种体位检测的食管体部其他参数指标比较差异无统计学意义（P＜0.05）。侧卧位测量的食管长度及食管下括约肌（LES）近端（距鼻腔）距离明显长于平卧位（P＜0.05），LES 静息压明显低于平卧位（P＜0.05），但侧卧位时LES 综合松弛压（IRP）与平卧位比较差异无统计学意义（P＞0.05）。侧卧位时远端收缩积分（DCI）和食团内压力（IBP）平均最大值明显低于平卧位（P＜0.05），但收缩前沿速度（CFV）两种体位比较差异无统计学意义（P＞0.05）。根据芝加哥分类（Chicago Classification v3.0，CCv3.0）相关分析参数，侧卧位除小型蠕动中断百分比明显高于平卧位（P＜0.05）之外，其他各项分析参数均与平卧位差异无统计学意义（P＞0.05），且食管动力异常诊断结果比较差异无统计学意义（P＞0.05）。

结论

尽管侧卧位时食管测压的参数与平卧位存在些许不同，但是LES 吞咽后达到的松弛程度一致，蠕动波的完整性一致，对于食管测压最后的结论无显著影响，芝加哥分类也不受影响。

Objective

To analyze the differences in high-resolution esophageal manometry （HREM）results between side-lying position and supine position.

Methods

A total of 137 patients with the symptoms of gastroesophageal reflux disease （GERD） such as heartburn, acid reflux, chest pain, and food regurgitation,who visited the department of gastroenterology at Xuanwu Traditional Chinese Medicine Hospital in Beijing from November 2019 to December 2022 were included in this study. were tested for HREM in a lateral position first, followed by a supine position, and then the similarities and differences in HREM results between the two positions were analyzed.

Results

The average residual pressure of the upper esophageal sphincter （UES） in side-lying position were significantly lower than those in supine position （P＜0.05）, but no statistically significant difference was found in the resting pressure and peak pressure of UES （P＞0.05）.Except of the average peak value and initial velocity of esophageal peristalsis in side-lying position were significantly lower than those in supine position （P＜0.001）, other parameters of the esophageal body in two positions （P＜0.05） were not different from each other in statistics. The length of the esophagus and the distance from the lower esophageal sphincter （LES） to the nasal cavity measured in side-lying position were significantly longer than those in supine position （P＜0.05）, and the resting pressure of LES was significantly lower than that in the supine position （P＜0.05）. However, differences with regard to the residual LES pressure between side-lying position and supine position （P＞0.05） were not significant. When lying on the side position, the distal contractile integral and maximum pressure inside the food mass were significantly lower than those in the supine position （P＜0.05）, but there was no significant difference in contractile front velocity （P＞0.05）. According to the Chicago classification analysis, except for a significantly higher percentage of small peristalsis interruption in side-lying position compared to supine position （P＜0.05）, there was no statistically significant difference in all other analysis parameters compared to supine position （P＞0.05）, as well as the final diagnosis for esophageal motor abnormality.

Conclusions

Although there were some differences in parameters of esophageal pressure measurement between side-lying and supine position, the degree of LES relaxation achieved after swallowing was consistent, as well as the integrity of peristaltic waves. There had no significant impact on the final diagnosis of esophageal pressure measurement, and the Chicago classification.