重灸中脘穴对脾胃虚寒型糖尿病胃轻瘫患者胃肠激素、胃动力学的影响

目的观察重灸中脘穴对脾胃虚寒型2型糖尿病胃轻瘫患者胃肠激素、胃动力学的影响。方法选取符合纳入标准的88例脾胃虚寒型糖尿病胃轻瘫患者,按随机数字表法分为治疗组和对照组,每组44例。对照组采用常规药物治疗,治疗组采用重灸中脘穴治疗。疗程结束后记录并对比分析两组临床疗效、胃肠激素[胃泌素(GAS)、胃动素(MTL)]、胃动力学(胃收缩频率、胃排空时间、胃排空率)、主要临床症状评分等变化。结果治疗组临床疗效明显优于对照组,差异具有统计学意义(P<0.05);两组治疗后GAS、MTL均明显优于治疗前(P<0.05),且治疗组明显优于对照组(P<0.05);两组治疗后胃收缩频率、胃排空时间、胃排空率均明显优于治疗前(P<0.05),且治疗组明显优于对照组(P<0.05);两组治疗后主要临床症状评分均明显优于治疗前(P<0.05),且治疗组明显优于对照组(P<0.05)。结论在常规药物治疗基础上重灸中脘穴治疗脾胃虚寒型2型糖尿病胃轻瘫,可调节胃肠激素,改善胃肠动力,促进胃肠功能恢复。     

至阳八阵穴隔附子饼灸治疗糖尿病胃轻瘫临床研究

目的观察至阳八阵穴隔附子饼灸治疗脾胃气虚型糖尿病胃轻瘫的疗效及对胃泌素(GAS)、胃动素(MTL)和血管活性肠肽(VIP)水平的影响。方法86例脾胃气虚型糖尿病胃轻瘫患者随机分为对照组和治疗组,每组43例。治疗组给予至阳八阵穴隔附子饼灸;对照组口服枸橼酸莫沙必利片。治疗12周后观察胃轻瘫主要症状指数量表症状积分改善情况、胃排空率及血清GAS、MTL、VIP水平。结果治疗组治疗后在胃轻瘫主要症状指数量表症状积分及胃排空率方面明显高于对照组,差异均有统计学意义(P<0.05)。治疗组治疗后血清GAS、MTL水平明显高于对照组,血清VIP水平明显低于对照组,差异均有统计学意义(P<0.05)。治疗组总有效率为90.7%,明显高于对照组的72.1%(P<0.05)。结论采用至阳八阵穴隔附子饼灸能快速促进糖尿病胃轻瘫患者胃功能的恢复,改善症状和体征,其作用机制可能与升高患者血清GAS和MTL水平,降低VIP水平有关。     

腹腔非胃手术后胃瘫综合征22例的临床分析

目的 探讨腹腔非胃手术后胃瘫综合征的病因、诊断与治疗。方法回顾性分析1972年至2004年间22例腹腔非胃手术后胃瘫综合征患者的临床资料。结果22例患者在手术后4-6d进食后出现上腹膨胀、恶心呕吐，吐物含有胆汁性胃液及食物。检查均发现上腹膨满、振水音明显和肠鸣音减弱。胃肠减压管每天可吸出1000-3000ml胆汁样胃液。行胃造影（稀钡或60％泛影葡胺）22例均显示胃无蠕动，呈松弛、静止状态；观察5—6h造影剂仍滞留胃内。予以持续胃肠减压、营养支持和维持水电解质、酸碱平衡；采用促进胃肠动力药物等非手术治疗；100％的患者于胃瘫发生后5—25（平均14．2）a恢复胃动力。结论腹腔非胃手术后胃瘫综合征是多种因素所致胃功能改变，经非手术可以治愈。     

升降散治疗糖尿病性胃轻瘫31例

目的：观察长用治疗糖尿病性胃轻竣的效果。方法：４１例糖尿病性胃轻竣分为治疗组３１例,对照组１０例。治疗组在用足量降糖药物的同时加用中药升降散治疗,疗程４Ｗ。对照组单用降糖药物治疗。结果：治疗组对上腹部饱胀、餐后不适、早饱恶心呕吐、嗳气等消化不良症状总有效率为８０．２％,对照组仅２１．３％,两组有非常显著性差异（Ｐ〈０．０１）。治疗后治疗组３ｈ和５ｈ钡条总排出率为８３．３３％和９６．６６％,对照组５     

Rapid improvement in post-infectious gastroparesis symptoms with mirtazapine

We report the case of a 34-year-old woman with severe post-infectious gastroparesis who was transferred from an outside medical facility for a second opinion regarding management.This patient had no prior history of gastrointestinal symptoms.However,in the aftermath of a viral illness,she developed two months of intractable nausea,vomiting,and oral intake intolerance that resulted in numerous hospitalizations for dehydration and electrolyte disturbances.A solid-phase gastric emptying scan had confirmed delayed emptying,confirming gastroparesis.Unfortunately,conventional pro-kinetic agents and numerous anti-emetic drugs provided little or no relief of the patient’s symptoms.At our institution,the patient experienced a cessation of vomiting,reported a significant reduction in nausea,and toler-ated oral intake shortly after taking mirtazapine.Based on mirtazapine’s primary action as a serotonin(5-HT)1a receptor agonist,we infer that this receptor system mediated the clinical improvement through a combination of peripheral and central neural mechanisms.This report highlights the potential utility of 5-HT1a agonists in the management of nausea and vomiting.We conclude that mirtazapine may be effective in treating symptoms associated with non-diabetic gastroparesis that are refractory to conventional therapies.     

Satiety testing： Ready for the clinic？

Drink tests are advocated as an inexpensive, nonivasive technique to assess gastric function in patients with a variety of upper digestive symptoms. Many patients with dyspeptic complaints will achieve satiation or develop symptoms at ingested volumes below those typically required to achieve these endpoints in controls. Substantial variation in test performance exists and a greater degree of standardization is required. Additionally, it remains unclear exactly what drink tests measure as correlations with measures of gastric sensation, accomodation and emptying are modest at best. Finally, results of drink tests do not guide therpay. At present, these tests are best reserved for research studies and are not advocated for use in clinical practice.     

血糖变化对糖尿病大鼠胃排空功能与胃促生长素表达的影响

目的研究血糖变化对糖尿病大鼠胃排空功能与胃组织胃促生长素（ghrelin）表达的影响，探讨不同病期糖尿病胃排空延迟与胃促生长素表达的关系。方法60只Wistar大鼠随机分为正常对照组（NC组）、糖尿病组（DM组）和胰岛素干预组（INS组）。腹腔注射链脲佐菌素（sTz）制备糖尿病大鼠模型，分别于给药后1和4周用酚红灌胃法检测胃排空；用免疫组化、半定量RT-PCR技术检测大鼠胃组织胃促生长素及其mRNA表达。结果注射STZ1周后，DM组大鼠的胃排空率、胃促生长素积分吸光度及mRNA表达均明显低于NC组和INS组（P〈0．05）。注射STZ4周后，DM组与INS组大鼠的体质量、胃排空率、胃促生长素积分吸光度均明显低于NC组，而胃促生长素mRNA的表达则高于NC组；DM组与INS组之间差异无统计学意义（P〉0．05）。结论短期血糖升高可能通过抑制胃组织胃促生长素表达参与胃排空延迟的发生；而长期高血糖可能通过促进胃促生长素的表达和释放来增加摄食、维持能量平衡。