糖尿病胃轻瘫中医证型与胃动力改变的关系

背景：糖尿病胃轻瘫(diabetic gastroparesis，DGP)的发病机制尚不十分清楚，其不同中医证型胃动力改变情况也尚未十分明了。目的：探讨DGP中医证型与体表胃电图(EGG)改变的关系。设计：以诊断为依据的病例对照研究。方法：对38例3种不同中医证型的DGP患者进行体表EGG检测，并与正常人20例进行对照。主要观察指标：糖尿病胃轻瘫肝胃不和型、脾胃虚弱型、胃阴不足型患者餐前餐后胃电参数与健康志愿者相应指标比较结果。结果：DGP3种中医证型的EGG餐前餐后主频及主功率、正常胃电慢波百分比、胃电节律紊乱百分比较正常人组间差异有显著性意义(y=2．054～2．680，P&;lt;0．05；t=2．738～3．528，P&;lt;0．01)，以胃动过缓明显增加、正常节律减少为其特征。结论：DGP的中医证型不同，胃电参数不一，胃肠动力功能存在明显差异，因此胃电参数可作为DGP中医辨证分型的客观依据之一，对康复措施的介入提供依据。     

30例2型糖尿病患者胃电图分析

目的：应用胃电图（EGG）研究2型糖尿病（DM）胃动力的变化。方法：选取2型糖尿病患者30例，正常对照组30例，对两组胃电图的主频（FP）、振幅（AP）、胃动过缓百分率（B％）的测定，并研究其与血糖水平的关系。结果：两组餐后AP均显著高于空腹（p〈0．05），但两组比较无统计学意义，两组餐前餐后B％比较，糖尿病组明显高于对照组（p〈0．05），研究还发现DMFGB与餐前餐后B％呈正相关，随FGB升高餐前餐后B％相关升高。结论：DM患者存在明显EGG异常，表现为胃动节律过缓明显增多的胃电节律紊乱．同时发现DMFGB升高与餐前餐后B％相关升高。     

1型糖尿病合并胃轻瘫的护理

糖尿病胃轻瘫(DGP) 是糖尿病常见的一种慢性并发症,国外流行病学调查表明,有50%～76 %的糖尿病患者合并有胃轻瘫,不仅1型糖尿病患者多见,2型亦很多见.它的主要特点是胃动力下降、胃排空迟缓、胃节律紊乱,而导致胃潴留.常见的症状包括早饱、恶心、腹胀、呕吐、打嗝、食欲不振、体重减轻等[1-2].     

1型糖尿病合并胃轻瘫的护理

糖尿病胃轻瘫（DGP）是糖尿病常见的一种慢性并发症,国外流行病学调查表明,有50％～76％的糖尿病患者合并有胃轻瘫,不仅1型糖尿病患者多见,2型亦很多见。它的主要特点是胃动力下降、胃排空迟缓、胃节律紊乱,而导致胃潴留。常见的症状包括早饱、恶心、腹胀、呕吐、打嗝、食欲不振、体重减轻等。本院于2007年1月至2009年3月收治11例1型糖尿病合并胃轻瘫患者,现报告如下。     

功能性消化不良胃电活动的临床观察

目的　探讨胃电活动对功能性消化不良 (FD)的临床诊断价值。方法　使用瑞典Digitrapper双电极胃电图记录仪 (EGG) ,检测 5 6例FD患者和 5 0例健康人的餐前、餐后 30分钟胃电活动变化。结果　FD组餐前胃电节律异常率 (4 8.2 % )显著高于健康对照组 (2 0 .0 % ) (P <0 .0 5 ) ;FD组餐后胃电节律异常率 (32 .1% )也显著高于健康对照组 (14 .0 % ) (P <0 .0 5 ) ;餐前、餐后主频不稳定系数率 :FD组与健康对照组比较差异有统计学意义 (P <0 .0 5 )。结论　FD存在餐前、餐后胃电节律紊乱 ,体表胃电图检查有助于发现FD的胃电异常     

功能性消化不良600例胃电图变化分析

目的：通过胃电图检查探讨功能性消化不良（FD）患者胃肌电紊乱的发生率,证实胃动力异常在FD发生中的作用。方法：600例FD患者行餐前和餐后体表胃电图检查,对正常胃慢波百分比和胃电主功率两项参数进行分析。结果：根据正常胃慢波百分比,本组中胃电节律正常130例（21.7%）,胃动过缓390例（65.0%）,胃动过速80例（13.3%）和混合性胃电节律紊乱组100例（16.7%）。在胃电节律正常的FD患者中,43.1%（56例）存在餐后/餐前胃电主功率比异常。结论：胃动力异常在FD的发病机制中起有重要作用。     

脾阴虚血瘀治疗方案对糖尿病性胃轻瘫患者胃动力学及胃肠激素参数的影响

目的观察脾阴虚血瘀治疗方案对糖尿病性胃轻瘫患者胃动力学及胃肠激素参数的影响。方法选取120例糖尿病性胃轻瘫患者,将其随机分为2组。对照组进行常规西医治疗,观察组以脾阴虚血瘀治疗方案进行治疗。比较2组患者治疗前及治疗后1、2及4周的胃动力学指标、餐前及餐后的胃肠激素参数。结果治疗后1、2及4周观察组的胃动力学指标、餐前及餐后的胃肠激素参数均显著优于对照组(P0.05)。结论脾阴虚血瘀治疗方案可有效改善糖尿病性胃轻瘫患者的胃动力学及胃肠激素参数。     

张兰从肝论治糖尿病胃轻瘫经验

正糖尿病胃轻瘫(diabetic gastroparesis,DGP)是一种临床常见的继发于糖尿病基础上的慢性并发症,是指胃在无机械性梗阻情况下出现的胃动力障碍,排空延迟的一组综合征,又叫糖尿病胃潴留或糖尿病胃麻痹。1958年Kassander首次提出糖尿病胃轻瘫的概念,且DGP患者的数量也随着糖尿病发病率的上升而增加[1.2]。据国内一些文献报道,在糖尿病患者中约有76%的人出现不同程度的胃排空延缓,且在1型和     

糖尿病胃轻瘫机制及饮食指导进展

糖尿病胃轻瘫（diabetic gastroparesis,DGP）,又称糖尿病胃麻痹,是1958年由Kassander首先明确定义的糖尿病常见的消化道慢性并发症,是继发于糖尿病的以胃自主神经功能紊乱而引起的胃动力低下为特点的临床症候群。临床常表现为腹胀,甚至餐后上腹部饱胀、恶心、     

糖尿病胃轻瘫患者血清一氧化氮与体表胃电变化的关系

胃轻瘫综合征是糖尿病患常见的并发症，以胃排空明显延缓而无上消化道器质性损害为特征，其发病机制尚不十分清楚。我们应用硝酸还原酶法，测定2型糖尿病胃轻瘫患的血清NO含量，同时动态监测其消化问期和消化期体表胃电变化规律，以探讨NO在糖尿病胃轻瘫发病机制中的作用。     

三黄脂消饮对糖尿病胃轻瘫大鼠血糖和胃排空率的改变

[摘要] 目的 研究三黄脂消饮对糖尿病胃轻瘫大鼠血糖和胃排空率的改变。方法 以三黄脂消饮治疗糖尿病胃轻瘫模型大鼠，并与正常组及模型组比较。结果 中药治疗后血糖下降，胃排空率增加。 结论 三黄脂消饮不仅可以降低糖尿病血糖水平，而且增加了并发症胃轻瘫的胃排空率，明显地改善了胃排空延迟，所以三黄脂消饮是治疗糖尿病胃轻瘫的有效药物。     

糖尿病性胃轻瘫应用胃动康治疗的效果(英文)

背景:现代医学对糖尿病性胃轻瘫的发病机制尚未完全阐明,应用胃动康治疗可能获得一定的疗效。目的:观察胃动康治疗糖尿病性胃轻瘫的临床疗效,并与吗丁啉的疗效进行对比。设计:病例-对照观察。单位:重庆师范大学校医院中医科,重庆市中医研究院。对象:选择2001-04/2005-12重庆师范大学校医院和重庆市中医研究院门诊及住院的糖尿病性胃轻瘫患者60例,随机分为两组:①治疗组(n=30):男20例,女10例,年龄31～58岁,病程0.5～26年。②对照组(n=30):男18例,女12例;年龄30～69岁,病程0.5～20年。所有患者对实验均知情同意。方法:治疗组口服胃动康水煎剂(由厚朴、枳实、槟榔、大黄、柴胡、白术、石斛组成,100mL/瓶,含生药100mg,由重庆市中医研究院制剂室提供),3次/d,30mL/次;对照组用吗丁啉,10mg/次,3次/d。用药4周。分别于治疗前后观察两组患者的症状积分、胃液体半排空时间、疗效评价、生活质量得分及安全性。主要观察指标:两组治疗前后的症状积分、胃液体半排空时间、疗效评价、生活质量得分及安全性比较。结果:60例糖尿病性胃轻瘫患者全部进入结果分析。①消化不良症状改善情况:治疗后,两组的症状积分和总积分均明显低于治疗前(P<0.01),治疗组的上腹胀满、恶心呕吐、食欲减退及上腹痛症状积分均明显低于对照组(P<0.05～0.01)。②临床疗效:治疗组总有效率90.0%(27/30),明显高于对照组[73.3%(22/30),P<0.05]。③胃液体半排空时间:治疗组治疗后较治疗前有明显改善(P<0.01)。④SF-36生活质量改善情况:治疗后,治疗组总体健康、躯体疼痛、活力及精神健康维度的得分明显高于治疗前(P<0.05);对照组总体健康和精神健康维度得分明显高于治疗前(P<0.05)。⑤安全性评估:治疗组治疗后实验室检查与治疗前比较,差异均不明显(P>0.05)。结论:胃动康治疗糖尿病性胃轻瘫具有良好的临床疗效和安全性。     

Effect of motilin on gastric emptying in patients with diabetic gastroparesis

OBJECTIVES: Because disturbances of gastric emptying are a serious complication in insulin-dependent diabetic subjects with regard to the maintenance of good metabolic control, we wanted to assess the effectiveness of motilin as a potential treatment for gastric emptying disturbances. RESEARCH DESIGN AND METHODS: The intestinal hormone motilin has been shown to accelerate gastric emptying in healthy subjects. Therefore, we examined the effect of intravenous motilin on gastric emptying of a 99mTc colloid-labeled semisolid test meal in 9 insulin-dependent diabetic patients with diabetic gastroparesis. All patients had a significantly delayed gastric emptying rate compared with a group of 11 healthy control subjects. RESULTS: During the infusion of motilin, gastric emptying was accelerated, and it was no longer significantly different from control values. CONCLUSIONS: These data demonstrate that motilin and related compounds such as erythromycin derivatives could be useful for the treatment of disturbed gastric emptying in diabetic subjects.     

按摩并吗丁啉对糖尿病性胃轻瘫患者胃动素及胃排空时间的影响

目的　研究按摩并吗丁啉对糖尿病性胃轻瘫 (DGP)患者胃动素、胃排空时间的影响。方法　将 10 0例DGP患者随机分为治疗组与对照组 ,每组各 5 0例。对照组予吗丁啉片 ,治疗组予按摩配合吗丁啉治疗 ,观察 6周。结果　治疗组和对照组总有效率分别为 92 %和 78% (P <0 .0 5 ) ,两组胃动素、胃排空时间均降低 (P <0 .0 5 ) ,但治疗组优于对照组 (P <0 .0 5 )。结论　按摩并吗丁啉对降低DGP患者的血浆胃动素、胃排空时间具有积极作用。     

胃轻瘫犬固体胃排空特征的超声评价

目的 探讨清醒状态下胃轻瘫比格犬的固体胃排空特征。方法 采用双侧迷走神经干切断术联合胰高血糖素复制胃轻瘫犬动物模型,运用超声成像技术评价比格犬正常和胃轻瘫状态下固体胃排空功能,并与核素SPECT闪烁成像结果进行比较。结果 比格犬的固体胃排空过程符合改良的指数模型：Y=1-(1-e-k1)β,胃轻瘫比格犬的胃半排时间较正常显著延长,差异具有统计学意义(P＜0.05)。结论 胃轻瘫比格犬的固体胃排空特征具有稳定的数学表达方式。     

Gastroparesis

Gastroparesis is a symptomatic disorder of the stomach characterized by slow or delayed gastric emptying. Diabetes and idiopathic factors account for over 60% of gastroparesis cases. Symptoms associated with delayed gastric emptying include nausea, vomiting, abdominal bloating and early satiety. Delayed gastric emptying due to gastroparesis is managed by dietary adjustments, prokinetic medications, avoidance of medications that retard gastric motor activity and optimizing glycemic control in diabetic patients. Electrical stimulation and gastric pacing are an evolving treatment option for patients who do not respond to standard medical therapy. This article provides a review of gastric motility, the etiologies of gastroparesis and therapeutic approaches to this disorder.     

Gastric emptying and electrogastrography in patients on CAPD.

OBJECTIVE: To evaluate if impaired gastric emptying of digestible solids can explain the disturbed eating behavior in continuous ambulatory peritoneal dialysis (CAPD) patients, and if predialytic and dialytic (CAPD and hemodialysis) patients with impaired gastric emptying have a higher prevalence of electrogastrographic (EGG) abnormalities. DESIGN: Cross-sectional study. After ingestion of a 99mTc-labeled test meal, anterior and posterior 1-minute scintigraphic acquisitions were collected every 5 minutes during the first 50 minutes and thereafter every 10 minutes until 2 hours had elapsed. Simultaneously, cutaneous EGG recorded gastric myoelectric activity. SETTING: The Division of Nephrology and the Department of Nuclear Medicine at the same academic teaching hospital. PARTICIPANTS: Thirty outpatients participated in both the gastric emptying and the EGG studies. Dialysis patients should have been on dialysis for more than 3 months. For comparison, 160 healthy control subjects participated in the gastric emptying study. MAIN OUTCOME MEASURES: The following parameters were used to describe gastric emptying: lag phase 90%, half-emptying time (T50), gastric retention at 90 and 120 minutes (Ret 90/120) and gastric emptying rate (GER, %/min). Electrogastrographic measurements were expressed as percentages of normal slow waves [2.4-3.6 cycles/min (cpm)], bradygastria (1.5-2.4 cpm), and tachygastria (3.6-10 cpm). RESULTS: T50 was prolonged, Ret 90 and Ret 120 were higher, and GER was slower in male CAPD patients compared to male controls. No significant differences were found in postprandial EGG. CONCLUSION: Gastric emptying is impaired in male non-diabetic CAPD patients. However, abnormalities in postprandial EGG cannot explain this finding.     

Selective reversal of hyperglycemia-evoked gastric myoelectric dysrhythmias by nitrergic stimulation in healthy humans

Acute hyperglycemia disrupts gastric myoelectric rhythm in healthy humans. Defective nitrergic function is a factor in animal models of diabetic gastropathy. We tested participation of nitrergic pathways in hyperglycemia-evoked myoelectric dysrhythmias and compared their role in preventing dysrhythmic actions of experimental motion sickness. Twelve healthy volunteers underwent electrogastrography (EGG) with and without intravenous 20% dextrose to produce plasma glucoses of 250 mg/dl. EGG continued for 2 h after oral nitroglycerin (9 mg) or the cyclic GMP-specific phosphodiesterase inhibitor sildenafil (100 mg). In separate studies, 12 volunteers underwent circular vection (60 degrees /s) without and 90 min after nitroglycerin (9 mg) or sildenafil (100 mg) with concurrent EGG. Hyperglycemia decreased recording time in normal rhythm, increased tachygastria more than 3-fold, and decreased power of the dominant frequency (P < 0.05). Nitroglycerin and sildenafil reversed effects of hyperglycemia, improving normal rhythm, decreasing tachygastria (both P < 0.05), and blunting power decreases. Neither agent affected EGG rhythm during euglycemia. Vection decreased time in normal rhythm and increased tachygastria (P < 0.05). However, nitroglycerin and sildenafil did not reverse dysrhythmic effects of vection (P = N.S.). In conclusion, administration of a nitric oxide (NO) donor or an inhibitor of cyclic GMP-selective phosphodiesterase reverses the dysrhythmic effects of hyperglycemia on gastric myoelectric activity in healthy humans. These agents have no effect on dysrhythmias during motion sickness. These findings are consistent with selective impairment of nitrergic function in this model of diabetic gastropathy and suggest that NO donors and other agents that increase NO activity may be useful for treating diabetic dysrhythmias.     

Understanding diabetic gastroparesis: a case study.

The purpose of this article is to present an overview of diabetic gastroparesis, defined as delayed gastric emptying in the absence of mechanical obstruction. Diabetic gastroparesis is a substantial and unrecognized problem. Failure to treat may result in a decreased quality of life and a potential increase for morbidity. The treatment protocol for diabetic gastroparesis combines dietary and pharmacologic measures. This article will discuss normal physiology of gastric emptying along with the pathogenesis of delayed emptying in patients with diabetes. Nursing implications for the care of the patient with diabetic gastroparesis is also presented along with commonly used pharmacologic agents.     

Gastric motility evaluated by electrogastrography and alternating current biosusceptometry in dogs

Association techniques could be the answer for evaluating electromechanical coupling and gastric emptying under basal conditions and after administration of drugs. Electrogastrography (EGG) and alternating current biosusceptometry (ACB) emerged due to their interesting nature, noninvasiveness and low cost. The aims were to examine in dogs the effect of erythromycin on gastric emptying by ACB and electrical and motor responses to erythromycin and propranolol by ACB and EGG respectively. Twelve beagle dogs ingested a solid test meal on separate days. Under anesthesia, gastric motility was evaluated by EGG and ACB after erythromycin and propranolol administration. Without anesthesia, gastric emptying was assessed under basal conditions and after erythromycin by ACB. ACB and EGG showed a strong temporal correlation. Erythromycin and propranolol presented the same profile with different power ratios; the amplitude increased whereas frequency decreased. Also, erythromycin administration hastened gastric emptying while reducing the orocaecal transit time. There is a demand for reliable, easy-to-perform and comfortable techniques to record gastric emptying and gastric activity in medicine and veterinary practice. In summary, the association of ACB with EGG accompanied by an appropriate animal model is promising for evaluating effects of drugs in gastric myoelectrical and contractile activity.