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관상동맥조영술상 정상인 환자에서 흉통의 원인으로 식도 운동장애에 관한 연구
황흥곤,김경수,김정현,임헌길,이방헌,이정균 한양대학교 의과대학 1992 한양의대 학술지 Vol.12 No.2
We conducted a prospective study to evaluate the importance of esophageal abnormality as a potential cause of recurrent non-cardiac chest pain in patients with normal or near normal coronary angiography including patients with variant angina, patients with syndrome X and also pateints with sighificant coronary artery disease. Standard esophageal manometry including edrophonium provocation test and acid perfusion test was performed in 50 patients with chest pain. The prevalence of esophageal motility disorder was 73%(8/11) in patients with variant angina, 67%(8/12) in patients with syndrome X, 86%(6/7) in patients with non-cardiac disease respectively. To evaluate the cause of spontaneous chest pain two chnnel ambulatory Holter monitoring, and esophageal motility and pH recording tests were perfromed simultaneously for 24 hours for the 16 patients with daily substernal pain and normal coronary angiography including 5 patients with daily substernal pain and normal coronary angiography including 5 patients with variant angina (group A), 5 patient with syndrome X(group B) and 6 patients with non-cardiac disease (group C). Each patient exeperienced more than one episode of spontaneous chest pain and the number of chest pain episode in each group was 22 in group A, 27 in group B, and 28 in group C respectively. The number of patinets with the chest pain and the frequency of the chest pain associated with gastroesophageal reflux were 4 and 29%(8/28) in group C. And the number of pateints with the abnormal motility were 2 and 14% (3/22) respectively in group A, 1 and 15%(4/27) in group B, and 4 and 29% (8/28) in group C. One patient in group A and two patients in group B experienced chest pain associated wkth gastroesophageal reflux and abnormal motility, but even a sigle episode of chest pain was not associated with gastroesophageal reflux and with abnormal motility simutaneously. So the number of patients with the chest pain and the frequency of the chest pain associated with esophageal desorder were 5 and 78% (17/22) respectively in group A, 3 and 48% (13/27) in group B, and 6 58% (16/28) in group C. On the contrary, the number of patients with the chest pain and the frequency of the chest pain associated with ST change in 24 hours Holter monitoringwere 3 and 18% (4/22) respectively in group A, 1 and 4% (1/27) in group B, and there was none in group C. In conclusion, esophageal disorders frequectly contribute to chest pain in patiects with variant angina, syndrome X and non-cardiac disease, so making a accurate diagnosis of the cause of chest pain may be beneficial to patient, and ambulatory esophageal motility and pH monitoring is useful in evaluation of chest pain.