Name: simultaneous laryngopharyngeal and conventional esophageal ph monitoring
Uploaded: 2020-12-14T12:30:00.000+00:00
Duration: 6 min 46 s
Description: Watch this Scientific Journal Video about Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring at JoVE.com

作者要感谢Restech提供的教育补助金。

以下研究方案由科隆大学医学院伦理委员会审查和批准。
注意:确保患者到达NPO进行以下胃肠功能测试。进行高分辨率测压以确定食管下括约肌 （LES） 的确切位置，并排除食管运动障碍疾病，如贲门失弛缓症。患者在服用抗分泌药物前应停用抗分泌药物至少 7 天，以确保有效的 pH 值测量。
1. 建立食管pH监测系统
<ol><li>将电池插入食管监测系统。</li>
	<li>将食管 pH 导管连接到设备。</li>
	<li>启动设备。确保日期和时间准确无误。选择" 开始研究"。</li>
	<li>在pH 4和7的溶液中校准导管，并在水中冲洗探头。将探头放在一边以便插入。</li>
</ol>2.首先用患者数据格式化SD卡，建立喉咽部pH监测系统。
<ol><li>将SD卡插入计算机并打开用于喉咽部pH监测的软件（例如，DataView 4）。通过单击" 新建 "并键入有关该患者的所有详细信息来添加新患者。单击" 保存 "将数据保存到SD卡。弹出SD卡并将其插入录像机。</li>
	<li>使用随附的螺丝刀将电池插入发射机，以卸下发射机外壳的盖子，然后安装新的 CR1632 纽扣锂电池。</li>
	<li>将两节AA电池插入录像机。</li>
	<li>打开录像机。使用向上/向下键选择 "设置"。按任意圆角键选择 设置 模式。如果需要，通过使用向上/向下键更改数字和任何舍入键来选择相应的值，从而修改时间和日期。如果时间和日期正确，请选择" 是 "并继续。</li>
	<li>当录像机询问"Tst PSG 适配器？" 时选择否。</li>
	<li>在主菜单中选择 学习 。</li>
	<li>现在会自动检测变送器。确认检测到正确的发射机，然后按任意圆键进行确认。发射器显示与录像机配对的序列号。</li>
	<li>将探头连接到变送器。 注:当连接到发射机时，探头尖端的红色发光二极管（LED）将每秒闪烁一次。LED 在四小时后停止闪烁，以延长电池寿命。</li>
	<li>选择 "水合物 "进行校准过程。通过将探针尖端置于清水溶液中并短暂搅拌，用提供的清水溶液对探针进行水合。按任意圆键开始补水过程。 注意:记录器将显示"补水"，并从"300秒"倒计时到零，或者当记录器检测到探头已补水时，将转换到15秒倒计时。将探头放在一边以便插入。</li>
</ol>3. 首先放置食管pH导管
<ol><li>确保患者坐直，直视并定期吞咽。用吸管提供一小杯水，以帮助吞咽。</li>
	<li>询问患者鼻子的哪一侧更清晰，更容易呼吸。</li>
	<li>将含有局部麻醉剂的局部凝胶涂抹在探针轴上，以便于插入。</li>
	<li>通过患者的鼻子插入探头，直接进入而不是向上。探头轴上的测量刻度有助于确定正确的位置。 注:正确位置比 LES 高 5 cm，之前已通过高分辨率测压仪确定。</li>
</ol>4. 固定食管 pH 导管
<ol><li>将探针尽可能靠近鼻孔，以确保在研究过程中使用手术胶带不会移动。</li>
	<li>将探头连接到脸颊，靠近鼻子。</li>
	<li>将探头套在耳朵上，并用胶带将探头固定在耳朵的颈部，耳朵后面和下方。</li>
</ol>5. 放置喉咽pH导管
<ol><li>确保患者坐直，直视并定期吞咽。</li>
	<li>将含有局部麻醉剂的局部凝胶涂在探针轴的远端，以便于插入。 谨慎: 不要将局部凝胶涂在传感器所在的探头尖端。</li>
	<li>将探针插入患者食管导管的相反鼻孔，向后直而不是向上。 注意:圆形探针尖端将帮助它围绕腭咽端口弯曲并进入口咽部。从患者鼻孔到口咽的距离通常可以通过使用从鼻孔到耳垂的距离来估计。</li>
	<li>确认红光清晰可见，位于悬雍垂的侧面或略低于悬雍垂。如果需要，使用压舌板以获得清晰的视野。 注意:如果触发了患者的呕吐反射，请将探针缩回口咽部的较高位置。</li>
</ol>6. 固定探头和变送器
<ol><li>将探针尽可能靠近鼻孔，以确保在研究过程中使用手术胶带不会移动。</li>
	<li>将探头连接到脸颊，靠近鼻子。</li>
	<li>将探头套在耳朵上，并用胶带将探头固定在耳朵的颈部，耳朵后面和下方。</li>
	<li>使用夹式发射器手提箱将发射器连接到患者的衣服上。</li>
</ol>7. 确保同时进行pH测量
<ol><li>确保两个pH测量设备的内部时钟同步。如果需要，请手动调整时间。</li>
	<li>同时开始食管和喉咽 pH 值检查。选择喉咽 pH 测量设备的 24 小时研究。</li>
</ol>8. 患者日记和说明
<ol><li>要求患者填写详细的日记，其中包括进餐时间，仰卧期的确切时间以及他们在研究期间经历的症状。</li>
	<li>向患者提供以下24小时测量周期的说明，以确保数据记录成功: 研究第1天三餐时间，研究第2天一餐时间。 晚上9点之前没有仰卧期。 像往常一样吃，喝，行为（可以做日常活动）。 谨慎: 设备不防水。</li>
</ol>9. 24小时研究结束后取出食管和喉咽探针
<ol><li>同时在两台设备上结束研究。<ol>
<li>通过同时按下位于中间的两个按钮结束食管pH研究，直到显示屏上出现"稍后上传"。</li>
		<li>通过同时按下咳嗽，ESC和胃灼热按钮结束喉咽部pH值研究，直到显示屏上出现"完成"。</li>
	</ol>
</li>
	<li>取下胶带，轻轻拉出两根导管。</li>
</ol>10. 解释食管pH值研究的结果
<ol><li>将设备连接到计算机。打开用于分析从食管pH测量设备获得的结果的软件，并上传患者的研究。</li>
	<li>手动输入患者数据和患者日记获得的信息，例如进餐时间，直立和仰卧期以及研究期间经历的症状。删除患者在研究期间可能意外执行的任何按钮按下。</li>
	<li>从数据分析中排除进餐时间。</li>
	<li>在报告中，查看为确定异常食管酸暴露而提供的重要参数和阈值，例如综合评分，低于基线的总pH值百分比（直立和仰卧）和事件总数。</li>
	<li>使用 pH <总和仰卧、直立和仰卧、总事件总数、持续时间超过 5 分钟的事件数和最长事件的持续时间14 计算研究期间的综合评分（DeMeester 评分）。确保报表显示复合分数。 注意:DeMeester 评分 > 14.72 显示食管酸暴露异常。</li>
</ol>11. 解释喉咽pH监测获得的结果
<ol><li>将SD卡插入计算机，打开用于分析喉咽pH测量系统获得的结果的软件。要上传研究，请单击检索。</li>
	<li>手动添加患者日记获得的信息，例如进餐时间，直立和仰卧期以及研究期间经历的症状。左键单击图表，然后拖动并突出显示要添加事件的区域，然后选择相应的事件。删除患者在研究期间可能意外执行的任何按钮按下。</li>
	<li>从数据分析中排除进餐时间。</li>
	<li>单击 "报告 "以查看显示研究期间口咽部酸暴露的图表，包括仰卧期，症状和进餐时间以及研究摘要。</li>
	<li>在报告中，查看重要的参数和阈值以确定异常的口咽酸暴露，例如复合评分，总pH低于基线（pH <5.5直立和pH<5仰卧）和事件总数。</li>
	<li>使用 pH 值低于 5.5 直立和仰卧的 % 时间计算直立和仰卧期的综合评分（RYAN 评分）、总事件数和最长事件持续时间8。确保报告中显示了直立和仰卧期的综合评分。 注意:RYAN 评分为 > 9.4 直立，> 6.8 仰卧位，显示口咽酸暴露严重异常。</li>
</ol>

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多洛雷斯·穆勒（Dolores Müller）从Restech获得了教育补助金。所有其他作者都没有什么可披露的。

食管 pH 监测通常用于确诊有典型反流症状的患者的 GERD。然而，除了典型的反流症状外，许多患者还会出现非典型反流症状，例如咳嗽或声音嘶哑，很可能与 LPR 有关。目前的指南建议使用PPI进行经验性试验，以证明这些症状的回流相关起源，并且缺乏标准化的客观测量2。喉咽 pH 值检测由于其位于食管上括约肌上方，为测量口咽酸异常暴露提供了一种新的客观诊断方法，并可能在这些患者中产生更可靠的结果。
以前的研究试图分析喉咽和食管pH监测之间的相关性9，10，11。然而，这些研究没有建立标准化的方案，仅包括少数患者（n ≤36），或者没有同时进行两种测量。因此，无法找到两种技术之间的有效相关性。Weitzendorfer等人最近发表了一个由70名患者组成的大型系列，除了对症状，生活质量和唾液采样进行全面评估外，还同时接受了食管和喉咽pH检测16。作者指出，口咽酸暴露阳性与任何其他客观或主观测试结果之间没有相关性。Wilhelm等人先前试图建立一个可靠的参考组，用于验证全胃切除术后患者的喉咽pH监测10。不幸的是，只有少数患者（n = 10）被纳入研究，并且由于直立和仰卧期未正确输入，因此无法获得有效结果。此外，没有进行食管pH监测来研究两种方法之间的相关性，或喉咽试验结果阳性的起源。我们最近发表了关于101名疑似GERD和食管外症状患者的喉咽和食管pH测量之间相关性的数据，并表明两种测量的结果不一定需要对应12。由于阈值不同，探针位置和病理生理学不同，两种方法的比较可能具有挑战性和误导性。我们认为，存在不止一种反流情况，食管和喉咽 pH 监测可相互补充，从而更好地评估这一具有挑战性的患者队列。我们同意以前的研究，即截至目前，单独的喉咽pH监测不适合作为GERD或LPR的筛查设备，需要进一步的研究来澄清非相关测试结果的起源。然而，我们之前的研究表明，这种标准化方案是这个具有挑战性的患者队列诊断途径的一个很好的补充，特别是对于手术决策。此外，我们开发了一种人类反流模型，用于食管切除术和胃间插重建后的患者。这些患者通常在术后出现严重的反流症状，并且没有反流屏障和有限的食管动力，这些概念是GERD病理生理学的重要因素。我们将该队列作为对照组，以进一步验证我们的标准化方案。最终数字尚未发表，但早期工作显示，在该体积反流模型13中，两种pH监测方法之间存在100%的相关性。
此外，以前的研究没有考虑到一些反流发作可能不会到达口咽部，从而导致可以在生理上解释的差异。此外，喉咽和食管 pH 值的不同阈值导致两种 pH 监测方法的复合酸暴露评分计算不同。虽然直立 pH 值为 < 5.5 或 <但口咽部 5.0 仰卧位 5.0 被认为是异常的，而远端食道的 pH 值为 < 4 则为异常8，14。因此，pH 值为 5 的反流发作在远端食管中被认为是正常的，但在口咽部被测量为异常反流发作。此外，DeMeester 评分 > 14.72 显示食管酸暴露异常，阴性评分表明患者没有病理性反流17。然而，只有严重的口咽反流导致> 9.4 直立和仰卧 6.8 > RYAN 评分异常。轻度或中度口咽酸暴露异常的患者可能仍具有正常的 RYAN 评分。
这种标准化方案可确保同时进行食管和喉咽 pH 测量。两个测量同时启动，内部时钟同步，以确保真正同步测量。此外，要求患者在整个测量过程中保持详细的饮食时间，症状，直立和卧位阶段的日记。然后，手动输入两个设备的日记条目，确保正确的时间和准确性。此外，这确保了相同的生活方式和日常变化在两个测量中都显示出来。
我们建议患者在此标准化方案之前至少停用抗分泌药物 7 天，以确保有效的 pH 测量。喉咽和食管 pH 监测在 PPI 上进行时表现出最高的敏感性和特异性。如果患者由于难以忍受的症状负荷或其他原因而无法暂停这种药物，仍然可以执行相同的方案。但是，与DeMeester和RYAN分数不同，数据的图形表示以及阻抗可以成为解释测试结果的有用工具。此外，该协议还包括手写日记。然而，患者还可以在两台设备上使用按钮按下来记录他们的症状和仰卧期，而不是详细的书面日记。我们的临床经验表明，对于大多数患者来说，写日记更容易，而且不容易出错。此外，如果需要，两种pH测量可以单独进行，但是，在这种情况下无法获得结果的相关性。我们通常首先放置食管探针，如视频手册所示。从科学的角度来看，首先放置哪个探头并不重要，但食管探头通常更难放置，使患者更容易从研究中最不舒服的部分开始，并且有两个鼻孔可供选择。如果探针卷曲或似乎无法向下传递到食道下部，则改变患者的头部位置和整体姿势可能会有所帮助。通常，使用另一个鼻孔可能导致探头的成功放置。如果喉咽测量探头的红灯停止闪烁，则在探头成功放置之前，可以重新安装发射器的电池以使其再次闪烁。
该方案的关键步骤包括准确测定 LES，确保食管 pH 探针正确放置在 LES 上方 5 cm 处，以及正确放置口咽 pH 探针位于悬雍垂的侧位或稍低于悬雍垂。只有正确放置两个探头，才能获得结果之间的有效相关性。此外，固定探头以保持精确位置是最重要的，也是最具挑战性的。特别是浓妆，面部毛发和炎热的日子会使固定探头变得复杂。此外，确保患者保持详细和诚实的日记和确切的时间对于以后将仰卧期，症状和进餐时间与测量的反流发作相关联至关重要。总体而言，我们队列中的所有患者都耐受两种pH探针。
该方法的局限性尤其在于探头的位置。食管 pH 监测已被证明可以确定 GERD14 患者异常酸暴露的可靠结果。然而，由于其位于 LES 上方 5 cm 处，因此无法对口咽部的酸暴露进行评估。我们通常使用我们机构的长探针阻抗pH监测系统，不仅可以测量食管远端的pH值，还可以测量推注运动和非酸反流事件。特别是，阻抗已被证明可以增加非典型症状患者的测量灵敏度18。然而，该方案也可用于常规远端食管pH监测系统。也可以使用无线远端食管pH监测来代替传统的测量系统。喉咽 pH 值检测提供食管上括约肌上方酸暴露的经过验证的测量，测量液体和汽化酸，但不能测量未到达口咽8 的回流发作。此外，日常生活方式的改变对24小时pH测量提出了挑战，因为患者在测量的时间段内可以有正常的测试结果，但是，在另一天抱怨反流症状，这还没有被测量。喉咽部pH监测系统为48小时的研究提供了一种选择，可以带来更可靠的结果。此外，最近还发布了一款用于评估喉咽pH监测结果的新软件。比较两个软件版本的研究表明，任何一个软件获得的结果都不能相互比较15。使用新的和改进的软件版本评估了这项研究的结果，但是，数据的回顾性比较可能受到使用不同软件版本的限制。
未来的研究需要解决喉咽pH监测是否可以用作LPR的筛查工具，以及这种新技术是否能够预测主要有非典型反流症状的患者的成功手术结果。然而，该方案的使用可确保维持对这一具有挑战性的患者队列中酸暴露的全面评估，并为补充喉咽和食管 pH 监测提供指导。

胃食管反流病（GERD）是最常见的良性疾病之一，影响西方国家高达20%的人1。除了胃灼热或反流等典型症状外，一些患者还可能出现咳嗽、声音嘶哑或哮喘等非典型症状2，3。尽管人们一致认为慢性咳嗽、慢性喉炎和哮喘可能具有与反流相关的起源，并且与喉咽反流 （LPR） 显著相关，但确切的病理机制仍不清楚。由于这些症状通常是多因素过程的一部分，因此它们描绘了一个巨大的诊断和治疗挑战4。
在疑似 GERD2 的患者中，远端食管 pH 监测位于食管下括约肌上方 5 cm 处，通常用于确定食管酸暴露异常。为了尝试使用相同的技术，近端常规pH监测在20世纪90年代后期被引入作为诊断设备，以测量当探针放置在UES或略高于UES时食管上括约肌（UES）的异常酸暴露。然而，这种方法并不总是提供有效和准确的结果，因为探针不是为口咽环境设计的，导致测量无效伪影，例如由探针5，6干燥引起的假反流事件。
最近，喉咽pH监测作为一种新的诊断设备被引入，专门设计用于测量口咽部的酸暴露，因为探针放置在UES上方，略微横向于悬雍垂（图1）。由于先前的研究表明，在主要有非典型症状的患者中，抗反流手术后成功结果具有80%的阳性预测值，因此这种新工具已成为选定患者诊断途径的宝贵补充。其泪滴传感器配备了锑技术，可检测液体和雾化酸，并且不需要直接接触粘膜来测量有效结果。此外，与近端pH监测相比，传感器可以抵抗干燥，从而可能导致更可靠的结果7，8。
目前关于伴随常规食管和喉咽pH测量相关性的文献很少。以前的研究要么只包括少数患者，要么没有同时进行两种测量9，10，11。我们最近发表了关于101名疑似GERD患者的大型队列中两种pH测量值之间相关性的数据。我们得出结论，喉咽和食管的pH测量不一定需要对应，因为存在各种不同的反流情景12。此外，我们还开发了一种人类反流模型，用于食管切除术和胃间置重建后的患者，显示两种pH监测方法在容量反流器中100%相关 13。
在这里，我们的目标是提供使用远端食管和喉咽部pH监测同时测量pH的说明。此外，还给出了关于分析复合酸暴露评分以及通过两种方法获得的结果之间的相关性的指导。此外，我们还介绍了使用同时监测食管和喉咽 pH 值评估的大型患者队列的最新数据。

<table><tbody><tr><td>AA Battery</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Calibration Solutions pH 4 and 7</td><td>Medtronic</td><td></td><td>part of the Digitrapper Reflux Testing system</td></tr><tr><td>CR 1632 Lithium coin cell battery</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Digitrapper pH &amp;amp; Impedance catheter</td><td>Medtronic</td><td></td><td></td></tr><tr><td>Digitrapper Recorder</td><td>Medtronic</td><td></td><td></td></tr><tr><td>Gelicain</td><td>PUREN</td><td></td><td>topical gel</td></tr><tr><td>Hydration vials with clear water</td><td>Respiratory Technology Corporation</td><td></td><td>part of the Restech Dx pH system</td></tr><tr><td>Leukoplast</td><td>BSN medical GmbH</td><td></td><td>surgical tape</td></tr><tr><td>Restech Dx pH probe</td><td>Respiratory Technology Corporation</td><td></td><td>part of the Restech Dx pH system</td></tr><tr><td>Restech Recorder</td><td>Respiratory Technology Corporation</td><td></td><td>part of the Restech Dx pH system</td></tr><tr><td>Restech Transmitter</td><td>Respiratory Technology Corporation</td><td></td><td>part of the Restech Dx pH system</td></tr><tr><td>Screwdriver</td><td>Respiratory Technology Corporation</td><td></td><td>part of the Restech Dx pH system</td></tr><tr><td>SD Card plus Adapter</td><td>Respiratory Technology Corporation</td><td></td><td>part of the Restech Dx pH system</td></tr><tr><td>tongue depressor</td><td>NOBAMED</td><td></td><td>wooden</td></tr></tbody></table>

simultaneous laryngopharyngeal and conventional esophageal ph monitoring

除典型反流症状外，许多胃食管反流病 （GERD） 患者还会出现食管外症状，如咳嗽、声音嘶哑或哮喘，这些症状可由喉咽反流 （LPR） 引起。由于其多因素起源，这些症状可能是一个巨大的诊断和治疗挑战。食管 pH 监测通常用于确定食管酸暴露异常和确诊 GERD。然而，为了更好地评估食管上括约肌上方的酸暴露，现在有一种新的喉咽 pH 测量系统，该系统可能在主要有食管外症状的患者中产生更可靠的结果。本文旨在提出一种使用食管和喉咽pH探针同时进行pH测量的标准化方案，以便从两种测量中获得酸暴露评分。

共有181名患者使用前面描述的标准化方案进行评估。前101例患者的病结果此前已发表12例。以下数据描述了先前发表的队列的扩展，然而，使用新软件评估通过喉咽pH测试获得的结果15。人口统计数据如 表1所示。所有患者均出现非典型症状，包括慢性咳嗽、声音嘶哑、咽痛或咽灼热。此外，大多数患者患有典型的胃食管反流病症状，如胃灼热、反流或吞咽困难。
通过喉咽部 pH 值测试获得的正常口咽酸暴露被定义为 RYAN 评分 < 9.4 直立和/或仰卧 6.8 <。正常的食管 pH 值结果被定义为 deMeester 评分为 < 14.72。 表2描述了通过两种pH测量获得的结果的详细数据。在喉咽测试结果正常的患者中，58名患者（55.2%）也表现出相应的食管pH测试正常，平均DeMester评分为5.3（范围0.3 - 14.1）。
直立位下更常出现口咽酸暴露异常，72例患者直立时RYAN评分异常，而仰卧位患者则显示RYAN评分异常，p值<0.0001。49例患者（64.5%）与食管远端酸暴露异常相关，DeMeester平均评分为64.7（范围15.5 – 285.4）。
总体而言，食管pH监测与喉咽pH监测之间的相关性，定义为两项测试均显示相应的异常或正常结果，在107例患者中可见（59%）。
口咽酸暴露异常见76例患者。在其中 27 名患者中，有 27 名患者（35.5%）出现不相应的正常食管远端酸暴露。有趣的是，11例口咽酸暴露异常但食管检查结果正常的患者在上消化道内镜检查期间显示反流相关的黏膜变化。在105名患者中发现正常的口咽测试结果。在其中 47 名患者中，有 47 名患者（44.8%）出现无相应异常的远端食管酸暴露。在25例食管酸暴露异常且口咽检查结果正常的患者中发现反流相关的粘膜改变。
26例患者在同时测量pH值后接受腹腔镜抗反流手术。16例患者（61.5%）显示口咽酸暴露异常，平均RYAN评分直立59.9（范围4.3 – 153.9）。在13例患者中观察到与远端食管酸暴露异常的相关性，平均DeMeester评分为90.4（范围20.4 – 283.5）。在手术候选者中，喉咽 pH 值异常结果与食管酸暴露异常的相关性提高到 81.2%。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td></td>
			<td>N</td>
			<td>%</td>
		</tr>
<tr>
<td>患者总数</td>
			<td>181</td>
			<td>100</td>
		</tr>
<tr>
<td>女性</td>
			<td>110</td>
			<td>60.8</td>
		</tr>
<tr>
<td>年龄（平均值;范围），年</td>
			<td>52</td>
			<td>22 – 86</td>
		</tr>
<tr>
<td>BMI（平均值;范围），公斤/平方米</td>
			<td>25.2</td>
			<td>18.4 - 46.8</td>
		</tr>
<tr>
<td>非典型反流症状</td>
			<td>181</td>
			<td>100</td>
		</tr>
<tr>
<td>返 流</td>
			<td>116</td>
			<td>64.1</td>
		</tr>
<tr>
<td>烧心</td>
			<td>127</td>
			<td>70.2</td>
		</tr>
<tr>
<td>吞咽 困难</td>
			<td>80</td>
			<td>44.2</td>
		</tr>
<tr>
<td colspan="3">手术治疗</td>
		</tr>
<tr>
<td>尼森</td>
			<td>15</td>
			<td>8.3</td>
		</tr>
<tr>
<td>图佩特</td>
			<td>4</td>
			<td>2.2</td>
		</tr>
<tr>
<td>林克斯</td>
			<td>4</td>
			<td>2.2</td>
		</tr>
<tr>
<td>内钨</td>
			<td>2</td>
			<td>1.1</td>
		</tr>
</tbody></table>表1:人口统计信息、症状和手术治疗。 显示了我们研究队列的详细人口统计信息和症状分布，如患者总数和研究队列的百分比。咳嗽，声音嘶哑和球状感觉总结为非典型症状。此外，该图还显示了有多少患者接受了手术治疗GERD以及选择了哪种方法。
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always"><tbody>
<tr>
<td rowspan="3"></td>
			<td colspan="5">喉咽 pH 值测试</td>
			<td colspan="3">食管 pH 值测试</td>
		</tr>
<tr>
<td></td>
			<td colspan="2">瑞安直立</td>
			<td colspan="2">瑞安仰卧</td>
			<td></td>
			<td colspan="2">德米斯特</td>
		</tr>
<tr>
<td>n (%)</td>
			<td>意味 着</td>
			<td>范围</td>
			<td>意味 着</td>
			<td>范围</td>
			<td>n (%)</td>
			<td>意味 着</td>
			<td>范围</td>
		</tr>
<tr>
<td>正常</td>
			<td>105 (58)</td>
			<td>1.12</td>
			<td>0 - 8.41</td>
			<td>0.33</td>
			<td>0 - 6.43</td>
			<td>85 (47)</td>
			<td>6.31</td>
			<td>0.3 - 14.2</td>
		</tr>
<tr>
<td>异常</td>
			<td>76 (42)</td>
			<td>52.8</td>
			<td>0 - 228.9</td>
			<td>2.92</td>
			<td>0 - 48.41</td>
			<td>96 (53)</td>
			<td>59.53</td>
			<td>14.8 - 285.4</td>
		</tr>
</tbody></table>表2:通过喉咽和食管pH测试获得的结果（n = 181）。 图中总结了喉咽和食管 pH 值测试获得的结果。正常的喉咽 pH 值定义为 RYAN 评分<直立 9.4，仰卧< 6.8。正常的食管 pH 值定义为 DeMeester 评分< 14.72。显示具有相应结果的患者总数，研究队列的百分比，RYAN或DeMeester评分的平均分数和范围。
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/61641/61641fig01.jpg"> 图1:喉咽pH检测系统。 该图显示了喉咽pH监测系统，该系统由记录仪和带有附加测量探针的变送器组成。此外，还显示了校准瓶以及用于水合过程的水瓶。 <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61641/61641fig01large.jpg" target="_blank">请点击此处查看此图的大图。</a>

Watch this Scientific Journal Video about Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring at JoVE.com

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

喉咽 pH 监测专门设计用于测量食管上括约肌上方的酸暴露，并补充主要表现为食管外反流症状的患者的诊断评估。怀疑喉咽反流（LPR）的患者同时使用远端食管和喉咽pH检测进行评估。

同时监测喉咽和常规食管 pH 值

In addition to typical reflux symptoms, many patients with gastroesophageal reflux disease (GERD) present with extraesophageal symptoms such as cough, ...

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Disorders of the Esophagus

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2.7K 次观看.  University of Cologne. 喉咽 pH 监测专门设计用于测量食管上括约肌上方的酸暴露，并补充主要表现为食管外反流症状的患者的诊断评估。怀疑喉咽反流（LPR）的患者同时使用远端食管和喉咽pH检测进行评估。

视频: Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring

Real-Time, Semi-Automated Fluorescent Measurement of the Airway Surface Liquid pH of Primary Human Airway Epithelial Cells

In recent years, the importance of mucosal surface pH in the airways has been highlighted by its ability to regulate airway surface liquid (ASL) hydration, mucus viscosity and activity of antimicrobial peptides, key parameters involved in innate defense of the lungs. This is of primary relevance in the field of chronic respiratory diseases such as cystic fibrosis (CF) where these parameters are dysregulated. While different groups have studied ASL pH both in vivo and in vitro, their methods report a relatively wide range of ASL pH values and even contradictory findings regarding any pH differences between non-CF and CF cells. Furthermore, their protocols do not always provide enough details in order to ensure reproducibility, most are low throughput and require expensive equipment or specialized knowledge to implement, making them difficult to establish in most labs. Here we describe a semi-automated fluorescent plate reader assay that enables the real-time measurement of ASL pH under thin film conditions that more closely resemble the in vivo situation. This technique allows for stable measurements for many hours from multiple airway cultures simultaneously and, importantly, dynamic changes in ASL pH in response to agonists and inhibitors can be monitored. To achieve this, the ASL of fully differentiated primary human airway epithelial cells (hAECs) are stained overnight with a pH-sensitive dye in order to allow for the reabsorption of the excess fluid to ensure thin film conditions. After fluorescence is monitored in the presence or absence of agonists, pH calibration is performed in situ to correct for volume and dye concentration. The method described provides the required controls to make stable and reproducible ASL pH measurements, which ultimately could be used as a drug discovery platform for personalized medicine, as well as adapted to other epithelial tissues and experimental conditions, such as inflammatory and/or host-pathogen models.

We present a protocol to make dynamic measurements of the airway surface liquid pH under thin film conditions using a plate-reader.

一次人气道上皮细胞气道表面液体 pH 值的实时、半自动荧光测量

In recent years, the importance of mucosal surface pH in the airways has been highlighted by its ability to regulate airway surface liquid (ASL) ...

科研

生物化学

Fast and Accurate Exhaled Breath Ammonia Measurement

This exhaled breath ammonia method uses a fast and highly sensitive spectroscopic method known as quartz enhanced photoacoustic spectroscopy (QEPAS) that uses a quantum cascade based laser. The monitor is coupled to a sampler that measures mouth pressure and carbon dioxide. The system is temperature controlled and specifically designed to address the reactivity of this compound. The sampler provides immediate feedback to the subject and the technician on the quality of the breath effort. Together with the quick response time of the monitor, this system is capable of accurately measuring exhaled breath ammonia representative of deep lung systemic levels. 
Because the system is easy to use and produces real time results, it has enabled experiments to identify factors that influence measurements. For example, mouth rinse and oral pH reproducibly and significantly affect results and therefore must be controlled. Temperature and mode of breathing are other examples. As our understanding of these factors evolves, error is reduced, and clinical studies become more meaningful. This system is very reliable and individual measurements are inexpensive. 
The sampler is relatively inexpensive and quite portable, but the monitor is neither. This limits options for some clinical studies and provides rational for future innovations.

Ammonia is an important physiologic metabolite relevant to various disease and wellness states. It is also a difficult molecule to measure in breath, which demands particular precautions be taken to obtain accurate results. Not all factors influencing ammonia are known, but progress can be difficult without accounting for these factors.

快速，准确的呼出气测量氨

This exhaled breath ammonia method uses a fast and highly sensitive spectroscopic method known as quartz enhanced photoacoustic spectroscopy (QEPAS) that ...

医学

Construction of a Wireless-Enabled Endoscopically Implantable Sensor for pH Monitoring with Zero-Bias Schottky Diode-based Receiver

Ambulatory pH monitoring of pathological reflux is an opportunity to observe the relationship between symptoms and exposure of the esophagus to acidic or non-acidic refluxate. This paper describes a method for the development, manufacturing, and implantation of a miniature wireless-enabled pH sensor. The sensor is designed to be implanted endoscopically with a single hemostatic clip. A fully passive rectenna-based receiver based on a zero-bias Schottky diode is also constructed and tested. To construct the device, a two-layer printed circuit board and off-the-shelf components were used. A miniature microcontroller with integrated analog peripherals is used as an analog front end for the ion-sensitive field-effect transistor (ISFET) sensor and to generate a digital signal which is transmitted with an amplitude shift keying transmitter chip. The device is powered by two primary alkaline cells. The implantable device has a total volume of 0.6 cm3 and a weight of 1.2 grams, and its performance was verified in an ex vivo model (porcine esophagus and stomach). Next, a small footprint passive rectenna-based receiver which can be easily integrated either into an external receiver or the implantable neurostimulator, was constructed and proven to receive the RF signal from the implant when in proximity (20 cm) to it. The small size of the sensor provides continuous pH monitoring with minimal obstruction of the esophagus. The sensor could be used in routine clinical practice for 24/96 h esophageal pH monitoring without the need to insert a nasal catheter. The &#34;zero-power&#34; nature of the receiver also enables the use of the sensor for automatic in-vivo calibration of miniature lower esophageal sphincter neurostimulation devices. An active sensor-based control enables the development of advanced algorithms to minimize the used energy to achieve a desirable clinical outcome. One of the examples of such an algorithm would be a closed-loop system for on-demand neurostimulation therapy of gastroesophageal reflux disease (GERD).

The manuscript presents a miniature implantable pH sensor with ASK modulated wireless output together with a fully passive receiver circuit based on zero-bias Schottky diodes. This solution can be used as a basis in the development of in vivo calibrated electrostimulation therapy devices and for ambulatory pH monitoring.

构建一种无线内窥镜植入式传感器，用于使用基于零偏置肖特基二极管的接收器进行pH监测

Ambulatory pH monitoring of pathological reflux is an opportunity to observe the relationship between symptoms and exposure of the esophagus to acidic or ...

生物工程

Intra-Operative Neural Monitoring of Thyroid Surgery in a Porcine Model

Intraoperative injury to the recurrent laryngeal nerve (RLN) can cause vocal cord paralysis, which interferes with speech and can potentially interfere with breathing. In recent years, intraoperative neural monitoring (IONM) has been widely adapted as an adjunct technique to localize the RLN, detect RLN injury, and predict vocal cord function during the operations. Many studies have also used animal models to investigate new applications of IONM technology and to develop reliable strategies for preventing intraoperative RLN injury. The aim of this article is to introduce a standard protocol for using a porcine model in IONM research. The article demonstrates the procedures for inducing general anesthesia, performing tracheal intubation, and experimental design to investigate the electrophysiological characteristics of RLN injuries. Applications of this protocol can improve overall efficacy in implementing the 3R principle (replacement, reduction and refinement) in porcine IONM studies.

This study aims to develop a standard protocol of intra-operative neural monitoring of thyroid surgery in a porcine model. Here, we present a protocol to demonstrate general anesthesia, to compare different types of electrodes, and to investigate the electrophysiological characteristics of the normal and injured recurrent laryngeal nerves.

猪手术模型对甲状腺手术的手术内神经监测

Intraoperative injury to the recurrent laryngeal nerve (RLN) can cause vocal cord paralysis, which interferes with speech and can potentially interfere ...

Combining Volumetric Capnography And Barometric Plethysmography To Measure The Lung Structure-function Relationship

Tools to measure lung and airways volume are critical for pulmonary researchers interested in evaluating the impact of disease or novel therapies on the lung. Barometric plethysmography is a classic technique to evaluate the lung volume with a long history of clinical use. Volumetric capnography utilizes the profile of exhaled carbon dioxide to determine the volume of the conducting airways, or dead space, and provides an index of airways homogeneity. These techniques may be used independently, or in combination to evaluate the dependence of airways volume and homogeneity on lung volume. This paper provides detailed technical instructions to replicate these techniques and our representative data demonstrates that the airways volume and homogeneity are highly correlated to lung volume. We also provide a macro for the analysis of capnographic data, which can be modified or adapted to fit different experimental designs. The advantage of these measures is that their advantages and limitations are supported by decades of experimental data, and they can be made repeatedly in the same subject without expensive imaging equipment or technically advanced analysis algorithms. These methods may be particularly useful for investigators interested in perturbations that change both the functional residual capacity of the lung and airways volume.

Here, we describe two measures of pulmonary function &#8211; barometric plethysmography, which allows the measurement of lung volume, and volumetric capnography, a tool to measure the anatomic dead space and airways uniformity. These techniques may be used independently or combined to assess airways function at different lung volumes.

体积摄影与气压面学相结合测量肺结构-功能关系

Tools to measure lung and airways volume are critical for pulmonary researchers interested in evaluating the impact of disease or novel therapies on the ...

Simultaneous pH Measurement in Endocytic and Cytosolic Compartments in Living Cells using Confocal Microscopy

Intracellular pH is tightly regulated and differences in pH between the cytoplasm and organelles have been reported1. Regulation of cellular pH is crucial for homeostatic control of physiological processes that include: protein, DNA and RNA synthesis, vesicular trafficking, cell growth and cell division. Alterations in cellular pH homeostasis can lead to detrimental functional changes and promote progression of various diseases2. Various methods are available for measuring intracellular pH but very few of these allow simultaneous measurement of pH in the cytoplasm and in organelles. Here, we describe in detail a rapid and accurate method for the simultaneous measurement of cytoplasmic and organellar pH by using confocal microscopy on living cells3. This goal is achieved with the use of two pH-sensing ratiometric dyes that possess selective cellular compartment partitioning. For instance, SNARF-1 is compartmentalized inside the cytoplasm whereas HPTS is compartmentalized inside endosomal/lysosomal organelles. Although HPTS is commonly used as a cytoplasmic pH indicator, this dye can specifically label vesicles along the endosomal-lysosomal pathway after being taken up by pinocytosis3,4. Using these pH-sensing probes, it is possible to simultaneously measure pH within the endocytic and cytoplasmic compartments. The optimal excitation wavelength of HPTS varies depending on the pH while for SNARF-1, it is the optimal emission wavelength that varies. Following loading with SNARF-1 and HPTS, cells are cultured in different pH-calibrated solutions to construct a pH standard curve for each probe. Cell imaging by confocal microscopy allows elimination of artifacts and background noise. Because of the spectral properties of HPTS, this probe is better suited for measurement of the mildly acidic endosomal compartment or to demonstrate alkalinization of the endosomal/lysosomal organelles. This method simplifies data analysis, improves accuracy of pH measurements and can be used to address fundamental questions related to pH modulation during cell responses to external challenges.

Several methods are available for measuring intracellular pH but very few of these allow simultaneous measurement of cytoplasmic and organellar pH. Here, we describe in detail a rapid and accurate methodology to simultaneously measure cytoplasmic and vesicular pH by ratiometric imaging of living cells.

同时进行pH测量的内吞和胞车厢中使用共焦显微镜活细胞

Intracellular pH is tightly regulated and differences in pH between the cytoplasm and organelles have been reported1. Regulation of cellular pH is crucial ...

生物学

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ quality exacerbated by excessive geographic transportation distance and stringent donor organ acceptance criteria pose limitations to current LTx efforts. Ex situ lung perfusion (ESLP) is an innovative technology that has shown promise in attenuating these limitations. The physiologic ventilation and perfusion of the lungs outside of the inflammatory milieu of the donor body affords ESLP several advantages over traditional cold static preservation (CSP). There is evidence that negative pressure ventilation (NPV) ESLP is superior to positive pressure ventilation (PPV) ESLP, with PPV inducing more significant ventilator-induced lung injury, pro-inflammatory cytokine production, pulmonary edema, and bullae formation. The NPV advantage is perhaps due to the homogenous distribution of intrathoracic pressure across the entire lung surface. The clinical safety and feasibility of a custom NPV-ESLP device have been demonstrated in a recent clinical trial involving extender criteria donor (ECD) human lungs. Herein, the use of this custom device is described in a juvenile porcine model of normothermic NPV-ESLP over a 12 h duration, paying particular attention to management techniques. Pre-surgical preparation, including ESLP software initialization, priming, and de-airing of the ESLP circuit, and the addition of anti-thrombotic, anti-microbial, and anti-inflammatory agents, is specified. The intraoperative techniques of central line insertion, lung biopsy, exsanguination, blood collection, cardiectomy, and pneumonectomy are described. Furthermore, particular focus is paid to anesthetic considerations, with anesthesia induction, maintenance, and dynamic modifications outlined. The protocol also specifies the custom device's initialization, maintenance, and termination of perfusion and ventilation. Dynamic organ management techniques, including alterations in ventilation and metabolic parameters to optimize organ function, are thoroughly described. Finally, the physiological and metabolic assessment of lung function is characterized and depicted in the representative results.

Normothermic Negative Pressure Ventilation Ex Situ Lung Perfusion: Evaluation of Lung Function and Metabolism

This paper describes a porcine model of negative pressure ventilation ex situ lung perfusion, including procurement, attachment, and management on the custom-made platform. Focus is made on anesthetic and surgical techniques, as well as troubleshooting.

非原位负压通气肺灌注:肺功能和代谢的评估

Lung transplantation (LTx) remains the standard of care for end-stage lung disease. A shortage of suitable donor organs and concerns over donor organ ...

<meta charset="utf8"></head><body>研究啮齿动物喉功能障碍的内窥镜方法

Minimally Invasive Murine Laryngoscopy for Close&#45;Up Imaging of Laryngeal Motion During Breathing and Swallowing

The larynx is an essential organ in mammals with three primary functions - breathing, swallowing, and vocalizing. A wide range of disorders are known to impair laryngeal function, which results in difficulty&#160;breathing (dyspnea), swallowing impairment (dysphagia), and/or voice impairment (dysphonia). Dysphagia, in particular, can lead to aspiration pneumonia and associated morbidity, recurrent hospitalization, and early mortality. Despite these serious consequences, existing treatments for laryngeal dysfunction are largely aimed at surgical and behavioral interventions that unfortunately do not typically restore normal laryngeal function, thus highlighting the urgent need for innovative solutions.
To bridge this gap, we have been developing an experimental endoscopic approach to investigate laryngeal dysfunction in murine (i.e., mouse and rat) models. However, endoscopy in rodents is quite challenging due to their small size relative to current endoscope technology, anatomical differences in the upper airway, and the necessity for anesthesia to optimally access the larynx. Here, we describe a novel transoral laryngoscopy approach that permits close-up, unobstructed video imaging of laryngeal motion in mice and rats. Critical steps in the protocol include precise anesthesia management (to prevent overdosing that abolishes swallowing and/or risks respiratory distress-related mortality) and micromanipulator control of the endoscope (for stable video recording of laryngeal motion by a single researcher for subsequent quantification).
Importantly, the protocol can be performed over time in the same animals to study the impact of various pathological conditions specifically on laryngeal function. A novel advantage of this protocol is the ability to visualize airway protection during swallowing, which is not possible in humans due to epiglottic inversion over the laryngeal inlet that obstructs the glottis from view. Rodents therefore provide a unique opportunity to specifically investigate the mechanisms of normal versus pathological laryngeal airway protection for the ultimate purpose of discovering treatments to effectively restore normal laryngeal function.

<meta charset="utf8"></head><body>微创小鼠喉镜检查用于呼吸和吞咽时喉部运动的特写成像

This protocol describes a serial transoral laryngoscopy approach for mice and rats that permits close-up, unobstructed video imaging of the larynx during breathing and swallowing using an optimized anesthetic regimen and finely tuned endoscopic manipulation techniques.

微创小鼠喉镜检查用于呼吸和吞咽时喉部运动的特写成像

The larynx is an essential organ in mammals with three primary functions - breathing, swallowing, and vocalizing. A wide range of disorders are known to ...

同时监测喉咽和常规食管 pH 值

摘要

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此视频中的章节

一次人气道上皮细胞气道表面液体 pH 值的实时、半自动荧光测量

快速，准确的呼出气测量氨

构建一种无线内窥镜植入式传感器，用于使用基于零偏置肖特基二极管的接收器进行pH监测

猪手术模型对甲状腺手术的手术内神经监测

体积摄影与气压面学相结合测量肺结构-功能关系

同时进行pH测量的内吞和胞车厢中使用共焦显微镜活细胞

非原位负压通气肺灌注:肺功能和代谢的评估

微创小鼠喉镜检查用于呼吸和吞咽时喉部运动的特写成像

微创小鼠喉镜检查用于呼吸和吞咽时喉部运动的特写成像

微创小鼠喉镜检查用于呼吸和吞咽时喉部运动的特写成像