儿童胃电图与胃镜对照观察136例

目的比较分析胃电图和胃镜对于儿童胃病诊断的一致性,探讨胃电图在儿童胃病检查中的临床诊断价值。方法136例因消化道症状住院或就诊的人同时经胃镜及胃电图检查的患儿进行比较,按胃镜诊断结果,观察胃电图与胃镜诊断的符合率,对比分析胃电图的主频、振幅和节律变化,探讨变化规律。结果与胃镜诊断相比,胃电图对慢性浅表性胃炎的诊断符合率高达95.8%,对器质性胃部疾病的诊断符合率不到40%。结论虽然胃镜仍为一种不可替代的检查手段,但胃电图对于儿童胃部功能性疾病的诊断却有着重要意义,可作为初筛的一种重要手段。     

Changes in Heart Rate Variability in Patients with Spleen-Qi Deficiency Syndrome

Many functional diseases are related to dysautonomia, and heart rate variability has been used to assess dysautonomia. However, heart rate variability has not been studied in Spleen-Qi deficiency syndrome (SQDS). Healthy volunteers (n = 37) and patients with SQDS (n = 67), recruited from the Clinic of the State University of Ecatepec Valley were included in the study. Outcome measures were average heart rate, standard deviation of the normal-to-normal heartbeat intervals, low frequency (LF), high frequency (HF) power, and the LF/HF ratio. Also, intestinal peristalsis, gastrointestinal symptoms (GSs), fatigue, and level of attention were measured. Standard deviation of the normal-to-normal heartbeat intervals (17 ± 2.3%) and HF (14 ± 3.1%) were lower in SQDS patients (17 ± 1.3%) than in healthy volunteers. SQDS patients had higher heart rate, LF power, LF/HF ratio, and fatigue scores (9.6 ± 1.12%, 16 ± 2.1%, 22 ± 3.8%, and 21 ± 4.1%). The fatigue correlated positively with the LF/HF ratio and negatively with HF power. The SQDS group had lower concentration performance (16.2 ± 1.9%) in the d2 test. The intestinal peristalsis showed a reduction (15 ± 1.3%) as compared with control. GS score and peristalsis correlated negatively with HF. Our results suggest that the pathology of SDQS could be associated with a low vagal tone which causes a decrease in peristalsis, increased fatigue, reduced attention, and appearance of GSs.     

针刺胃经下肢段及非经非穴点对胃电的影响

目的探讨足阳明胃经对胃功能调控的相对特异性。方法静脉持续输入盐酸山莨菪碱制作胃电节律规整性下降的异常状态背景。针刺胃经穴位足三里、梁丘以及穴位旁开1．5cm的非经非穴点，比较足三里、梁丘及其穴位旁开对照点对胃电节律的调整作用。结果足三里、梁丘及其穴位旁开对照点均能对抗盐酸山莨菪碱引起的胃电节律规整性下降。足三里、梁丘穴较其旁开对照点对胃电节律的调整作用好。结论足阳明胃经下肢段对胃功能调控具有相对特异性。     

Impaired gastric slow wave rhythmicity in patients after bone marrow or stem cell transplant

Patients after bone marrow or stem cell transplant often develop gastrointestinal symptoms. The aim of this study was to investigate possible impairment of gastric myoelectrical activity in these patients. The study was performed in 15 patients who had had bone marrow or stem cell transplant and 13 healthy subjects. Gastric myoelectrical activity was assessed using electrogastrography. The electrogastrogram (EGG) was made for 30 min in the fasting state and 60 min after a test meal (475 kcal; turkey sandwich). Overall and minute-by-minute spectral analyses were performed to derive various parameters of the EGG. Compared with the healthy controls, the patients showed a significantly higher percentage of arrhythmia (no obvious rhythmicity observed in the EGG) in both fasting (17.6 ± 3.8% vs 7.1 ± 2.17%, P < 0.02) and fed (11.4 ± 2.65% vs 4.19 ± 1.04%, P < 0.02) state. The patients showed a significantly higher instability coefficient of the dominant frequency in the fasting state than in the controls (0.51 ± 0.06 vs 0.29 ± 0.18, P < 0.008). The total average symptom score was 3.93 ± 0.84 in the patients and 0 in the controls, and a relatively weak but significant correlation was found between the symptom scores and the percentage of arrhythmia in the patients in fed state (r = 0.69, P < 0.02). It was concluded that patients with bone marrow or stem cell transplant have excessive arrhythmia that is correlated with their dyspeptic symptoms.     

Changes in gastric myoelectric activity during space flight

The purpose of the present study was to examine postprandial myoelectric activity of the stomach and gastric activity associated with space motion sickness using electrogastrography. Three crewmembers participated in this investigation. Preflight, subjects exhibited normal postprandial responses to the ingestion of a meal. Inflight, crewmembers exhibited an abnormal decrease in the power of the normal gastric slow wave after eating on flight day 1, but had a normal postprandial response by flight day 3. Prior to and during episodes of nausea and vomiting, the electrical activity of the stomach became dysrhythmic with 60–80% of the spectral power in the bradygastric and tachygastric frequency ranges. These findings indicate that gastric motility may be decreased during the first few days of space flight. In addition, changes in the frequency of the gastric slow wave associated with space motion sickness symptoms are consistent with those reported for laboratory-induced motion sickness.     

儿童青少年1型糖尿病患者胃动力调查结果分析

目的探讨不同病程1型糖尿病患儿胃动力变化及血糖对胃动力的影响。方法正常对照组（A组）24例。1型糖尿病组49例,其中B组为新诊断者28例,平均病程1.5个月;C组为病程3年以上者21例,平均病程6.3年。对上述对象做胃电图检查。糖尿病组进行钡条胃排空试验,同时测定空腹和餐后2h血糖。问卷调查消化道症状。结果问卷调查显示,B组仅1例有消化道症状（占3.6%）,C组有消化道症状10例（占47.6%）,两组差异有统计学意义（P=0.001）。B组有4例出现胃排空延迟,C组有1例,两组差异无统计学意义（P=0.54）。两组胃电图与正常对照组相比,餐前、餐后,胃窦、胃体振幅差异无统计学意义;B组胃体餐后频率低于A组（P〈0.01）;C组胃窦、胃体餐后频率均低于A组（P〈0.05）;B组胃窦餐前振幅低于C组（P〈0.05）。未发现血糖水平、糖化血红蛋白（HbA1c）与胃排空、胃电参数的相关性（P〉0.05）。结论糖尿病组尤其是长病程组消化道症状发生率显著高于正常对照组。儿童青少年1型糖尿病患者病程早期可见胃排空延迟,糖尿病患儿餐后胃电频率下降,提示儿童青少年1型糖尿病患者早期即可出现胃动力异常。     

胰十二指肠切除术病人胃电图变化

通过对胰十二指肠切除术病人手术前后体表胃电图的研究，探讨手术对病人胃电及排空功能的影响。结果表明：保留幽门的胰十二指肠切除术病人术前６０％存在胃律紊乱及胃排空障碍，８０％此类病人术后出现胃电及胃排空异常。上述结果提示：对拟行保留幽门的胰十二指肠切除术病人术前胃电图检查表现胃节律紊乱及胃排空障碍者，术中应考虑胃及空肠造瘘。     

Electrical activity from colon overlaps with normal gastric electrical activity in cutaneous recordings

The stability of EGG recordings is affected by a variety of artifacts. The aim of this study was to investigate possible overlapping of dominant frequencies in recorded cutaneous electrical activity arising simultaneously from the stomach and/or colon. Ten normal volunteers, eight posttotal colectomy patients, and four patients posttotal gastrectomy were studied. Fasting cutaneous recordings were obtained using four pediatric ECG electrodes attached to the abdominal surface. Electrical activity was recorded and digitally analyzed using custom-designed software. Spectral analysis after gastrectomy and colectomy showed persistence of power peaks in the gastric electrical activity range of frequency (2.5–3.75 cpm). In conclusion, noninvasively obtained colonic frequencies overlap EGG. This hypothesis is supported by the persistence of power peaks in the EGG range of frequency after gastrectomy and colectomy. Therefore, we conclude that contribution of electrical activity arising from the colon could substantially affect EGG recordings.     

Gastric Dysrhythmias and Transient Sleep Impairment in Healthy Subjects

Studies have shown that impaired sleep quality is associated with exacerbation of gastrointestinal problems. The aim of this study was to measure gastric myoelectrical activity and visceral perception to fullness before and after a water load in healthy volunteers with or without transient sleep impairment. Twenty-eight male subjects (mean age, 39.3 years; range, 14-58 years) were studied. The subjective sleep quality was measured by visual analogue scale (bad [0] to very good [100]. Gastric myoelectrical activity was recorded and analyzed before and after the subjects ingested water until full. Subjects were stratified into two groups, i.e., with impaired sleep quality (Group A [Gr-A]; n = 15; mean age, 35.1 years) and with fine sleep quality (Group B [Gr-B]; n = 13; mean age, 40.7 years). Gr-A subjects ingested less water (514 +/- 21 ml) compared to the Gr-B subjects (621 +/- 50 ml: P < 0.05). After ingestion of the water load, Gr-A had significantly less 2.5- to 3.75-cpm activity (28.0 +/- 4%) by 21-30 min and more tachygastric activity (28 +/- 2 and 30 +/- 4%) by 11-30 min compared with Gr-B (43 +/- 5, 20 +/- 2, and 18 +/- 2%, respectively; P < 0.05). There was a significant positive correlation between sleep quality and the percentage of power in the normal range by 21-30 min after the water load (r = 0.5, P < 0.01). In contrast, a negative correlation was observed between sleep quality and tachygastric activity by 11-20 min (r = -0.4, P < 0.05) and 21-30 min (r = -0.4, P < 0.05) after ingestion of water. Transient sleep impairment is associated with increases in gastric dysrhythmia and altered perception to gastric distension in response to the water load. The study provides a potential clue that transient sleep impairment might influence gastric myoelectrical functioning in healthy individuals.