肝病患者的胃动力障碍及西沙必利的改善作用

本利用B型超声方法检测了20名正常志愿及50例肝硬化、肝癌患的胃液体排空功能，同时观察单剂量西沙必利对患胃排空的影响．结果显示正常胃液体半排空时间(T1／2)为13．90±4.30分钟。肝硬化患为39．36±12.30分钟。肝癌患为40．50±8.91分钟，病人与正常对照之间有非常显的差别．口服西沙必利10mg半小时后患T1／2明显缩短至24．33±11.17分钟．P<0．05．从而说明了慢性肝病患胃动力障碍的存在，从另一角度解释丁部分肝硬化、肝癌病人的消化道症状，并提示西沙必利对这种障碍的改善作用，为该类病人临床应用西沙必利缓解症状提供了理论依据．     

肝病患者的胃动力障碍及西沙必利的改善作用

本文利用B型超声方法检测了20名正常志愿者及50例肝硬化、肝癌患者的胃液体排空功能,同时观察单剂量西沙必利对患者胃排空的影响。结果显示正常胃液体半排空时间(T1/2)为13.90±4.30分钟,肝硬化患者为39.36±12.30分钟,肝癌患者为40.50±8.91分钟,病人与正常对照之间有非常显著的差别。口服西沙必利10mg半小时后患者T1/2明显缩短至24.33±11.17分钟,P<0.05。从而说明了慢性肝病患者胃动力障碍的存在,从另一角度解释了部分肝硬化、肝癌病人的消化道症状,并提示西沙必利对这种障碍的改善作用,为该类病人临床应用西沙必利缓解症状提供了理论依据。     

门脉高压患者胃动力障碍研究

肝硬化门脉高压症患者常伴有胃动力障碍，如腹胀、食欲不振、早饱、反酸、恶心、腹泻、便秘等，导致进食减少，营养不良。近年来，国内外学者对肝硬化门脉高压症与胃肠动力的关系进行了许多研究，本文主要介绍肝硬化患者的胃动力改变的发生机制及临床治疗进展。     

新型胃动力性药物西沙必利的临床应用

西沙必利是一种新型胃动力性药物,通过肠肌层神经丛释放乙酰胆碱而起作用。其效果比胃复安强100倍,可增强胃部收缩,提高胃的张力,改善胃窦阳十二指肠的协调作用,加速胃肠道内半固体或固体食物的转运时间,且无抗多巴胺副作用。可用于胃食管反流、反流性食管炎、食管下端括约肌功能障碍、糖尿病性胃麻痹、胃手术后、胃溃疡、慢性胃炎及全身性神经肌肉疾病所致胃排空延迟的疾病。     

糖尿病胃动力障碍和促胃动力药的作用

目的 研究2型糖尿病(DM)胃动力变化和观察西沙必利对DM胃轻瘫的疗效。方法 对74例2型DM患者以SPECT显像技术用核素标记~(113)In液体试餐、~(99m)Tc固体试餐测定胃半排空时间(GET_(1/2))和进行胃电图(EGG)检查,同时检测空腹血糖(FBG)。结果 (1)22例FBG≤7.8mmol/L的糖尿病患者,未见GET_(1/2)延迟;52例FBG>7.8mmol/L的糖尿病患者,36例(69.2％)固相GET_(1/2)延迟,其中14例伴液相GET_(1/2)延迟(P<0.01)。(2)正常对照组和DM组的空腹和餐后胃电图主频、平均过零频率差异均无显著性,两组餐后振幅均显著高于空腹(P<0.05)。DM组的胃电节律紊乱率较对照组显著增高(P<0.05)。(3)FBG>7.8mmol/L的DM患者,核素胃排空(RGE)与EGG相关。(4)36例DM胃轻瘫分两组:A组降糖药加西沙必利和B组单用降糖药用药4周。A组对胃轻瘫有效率85％,B组无效。结论FBG与DM患者胃排空呈负相关;血糖控制不良的DM患者,RGE与EGG相关;西沙必利对DM胃轻瘫有一定疗效。     

西沙必利对大鼠失血性休克复苏后胃损害的作用

目的：观察西沙利对大鼠失血性休克复苏后胃损害的作用。方法：108例只Wistar大鼠随机分为假休克（SS）组、失血性休克复苏（HS）组和失血性休克复苏后西沙必利治疗（HSC）组，同位素标记生物微球法测量胃血流量，同时测定胃粘膜内pH(pHi)、胃排空、胃MDA含量和Na^ -K^ -ATPase活性，以及门静脉血乳酸水平。结果：HSC组与HS相比，大鼠胃内色素相对残留低率显降低，胃血流量显下降，胃pHi有显回升，4h胃粘膜MDA含量降低、Na^ -K^ -ATPase活性增加，门静脉血乳酸水平显下降。结论：失血性休克复苏后西沙必利促胃动力治疗，通过增加胃血流量，有助于改善复苏后持续存在的胃缺血缺氧状况。     

西沙必利对功能性消化不良患者胃动力、胃动素、胃泌素影响的研究

对３０例功能性消化不良（ＦＤ）患者服用西沙必利前后的胃腔内压力、血中胃动素及胃泌素的变化进行检测，并以１１例正常人作对照。结果：①ＦＤ患者胃窦和胃体基础压、胃窦蠕动压及血中胃动素浓度，明显低于正常对照组（Ｐ值分别＜００５，＜００１）；而胃窦蠕动波持续时间、血中胃泌素浓度与正常组无显著差异（Ｐ＞００５）。②服用西沙必利后，ＦＤ患者与正常对照组胃窦和胃体基础压、胃窦蠕动压及血中胃动素浓度，均较服药前明显升高（Ｐ＜００５，Ｐ＜００１）。而胃窦蠕动波持续时间和血中胃泌素浓度，正常组和ＦＤ组服药前后均无显著差异（Ｐ＞００５）。结论：ＦＤ与胃动力障碍有关，西沙必利治疗ＦＤ是合理、有效的     

胃动力障碍的治疗现状与研究进展

胃动力障碍的饮食管理　　饮食管理在胃动力障碍的治疗中占非常重要的地位 ,临床医生和患者对此往往重视不够[1] 。胃动力障碍患者都有腹胀、腹痛、恶心或呕吐等 ,严重影响食欲 ,但全身营养维持仍然主要经口饮食。只有很小一部分症状极为严重的患者 ,才可能需要肠道营养或全胃肠外营养支持。对于能经口饮食的患者 ,要特别注意改进饮食的质与量 ,以利于胃排空。液状食物比固体食物排空要快 ;脂肪和多纤维素食物则延缓胃排空。因此 ,少量、多餐、低脂、以碳水化合物为主的流质、半流质饮食 ,可以减轻患者上腹部饱胀、早饱和恶心。避免进食生葱…     

胃电起搏治疗胃动力障碍疗效观察

背景:胃电起搏是近年来开展起来的一项治疗胃动力障碍的新方法,其疗效尚不明确。目的:观察胃电起搏治疗对胃动力障碍患者胃肌电活动和症状的影响,以评估其对胃功能紊乱的疗效。方法:对13例胃动力障碍患者行胃电起搏治疗,治疗前后进行胃电图检查和症状评估。结果:胃电起搏治疗后,患者的餐前正常胃电慢波百分比(46.9％±21.6％)与治疗前(41.9％±16.9％)相比无显著差异(P>0.05),餐后正常胃电慢波百分比(78.7％±16.6％)则显著高于治疗前(57.5％±28.6％,P<0.01);治疗后患者的症状亦明显改善。结论:胃电起搏治疗能在短期内改善胃动力障碍患者的胃电节律紊乱和症状。     

Postprandial antropyloroduodenal motility and gastric emptying in gastroparesis--effects of cisapride.

There is little information about the organisation of antroduodenal contractions or pyloric motility in patients with gastroparesis. The mechanisms responsible for the acceleration of gastric emptying by cisapride in patients with gastroparesis are also poorly understood. Simultaneous manometric and scintigraphic recordings were performed in 12 patients with gastroparesis and nine healthy volunteers before and after cisapride administration. Antropyloroduodenal pressures were recorded with a sleeve/side hole manometric assembly and gastric emptying with a scintigraphic method. Thirty minutes after the solid component of the test meal had begun to empty from the stomach all subjects received 5 mg cisapride intravenously over 10 minutes and recordings continued for a further 60 minutes. In the 30 minutes before cisapride there was no significant difference in the number of antral pressure waves (median 20 v 33, NS), basal pyloric pressure, or the number of isolated pyloric pressure waves between patients and volunteers, but the number of antral waves of extent > or = 6 cm (median 1 v 5, p < 0.05) was less in the patients, as was gastric emptying (8% v 20%, p < 0.05). In the patients, there was no change in the number of antral waves after cisapride, but there was an increase in the number of antral waves > or = 6 cm in extent (median 7 v 1, p < 0.05) and in the rate of gastric emptying (26% v 8%, p < 0.01). In the healthy subjects, cisapride increased gastric emptying (31% v 20%, p < 0.05), but reduced the number of antral waves (10 v 33, p < 0.05). Cisapride had no significant effect on the number of antral waves of extent more than or equal to 6 cm (11 v 5, NS). The number of isolated pyloric pressure waves decreased after cisapride (4 v 11, p < 0.05). There was a relationship between gastric emptying and the number of antral pressure waves of extent more than or equal to 6 cm in both the patients (r=0.38, p<0.05) and healthy subjects (r=0.05, p<0.01). There was no significant relationship between gastric emptying and the number of antral waves. It is concluded that disturbance of the relationship between antral, pyloric, and duodenal pressure waves is a major abnormality of postprandial gastric motor function in patients with gastroparesis. The stimulation of antral pressure waves of extent more than or equal to 6 cm may contribute to the acceleration of gastric emptying produced by cisapride in patients with gastroparesis and in normal subjects.     

The effect of cisapride on oesophageal motility and lower sphincter function in patients with gastro-oesophageal reflux disease

OBJECTIVES : To evaluate the efficiency by which the 5-HT4 agonist cisapride affects important motor functions involved in the control of gastro-oesophageal reflux. METHOD : Thirty patients with proven gastro-oesophageal reflux disease (endoscopy and 24 h pH-metry) were included in a randomized, double-blind, placebo controlled study with a cross-over design. Cisapride, 20 mg b.i.d., during 4 weeks was compared with placebo. At baseline, as well as after 4 and 8 weeks all patients underwent symptom assessments, sleeve manometry with concomitant oesophageal pH-monitoring and an acid clearance test. RESULTS : Despite adequate plasma levels cisapride had no significant effect on swallow induced peristaltic amplitude, duration, propagation speed, the elicitation of secondary peristalsis nor on acid clearance. Neither the basal tone of the lower oesophageal sphincter nor the number of transient lower oesophageal sphincter relaxations induced by gas distension of the stomach was affected by the administered dose of cisapride. CONCLUSION : Although cisapride has been alleged to improve symptoms as well as the oesophagitis in patients with gastro-oesophageal reflux disease, we found the compound (20 mg b.i.d.) devoid of effects on important motor mechanisms involved in the pathogenesis of the disease.     

Long-Term treatment with cisapride and antibiotics in liver cirrhosis: effect on small intestinal motility, bacterial overgrowth, and liver function

OBJECTIVES: Altered small-bowel motility, lengthening of the orocecal transit time, and small-intestinal bacterial overgrowth have been described in patients with liver cirrhosis. These changes might be related to the progressive course and poor prognosis of the disease. We investigated the effect of a long-term treatment with cisapride and an antibiotic regimen on small-intestinal motor activity, orocecal transit time, bacterial overgrowth, and some parameters of liver function. METHODS: Thirty-four patients with liver cirrhosis of different etiology entered in the study. They were randomly allocated to receive cisapride (12), an alternating regimen of norfloxacin and neomycin (12), or placebo (10) during a period of 6 months. At entry and at 3 and 6 months, a stationary small-intestinal manometry was performed, and orocecal transit time and small-intestinal bacterial overgrowth were also investigated using the H2 breath test. Liver function was estimated with clinical and laboratory measurements (Child-Pugh score). RESULTS: After 6 months, both cisapride and antibiotics significantly improved fasting cyclic activity, reduced the duration of orocecal transit time, and decreased small-intestinal bacterial overgrowth. Cisapride administration was followed also by an increase in the amplitude of contractions. No statistically significant variations in these parameters were observed with placebo. An improvement of liver function was observed at 3 and 6 months with both cisapride and antibiotics. CONCLUSIONS: Long-term treatment with cisapride or antibiotics reversed altered small-intestinal motility and bacterial overgrowth in patients with liver cirrhosis. These findings suggest a possible role for prokinetics and antibiotics as a modality of treatment in selected cases of decompensated cirrhosis.     

功能性消化不良的胆囊排空功能及西沙必利的应用研究

目的研究功能性消化不良（ＦＤ）的胆囊排空功能以及西沙必利在此中的作用。方法对９１例ＦＤ患者与３０名健康对照者于空腹和试餐后Ｂ超检查测算胆囊容积、胃面积和胆囊排空率（ＧＢＥＦ）。结果约１／３ＦＤ患者存在胆囊排空功能低下，ＦＤ组ＧＢＥＦ明显低于正常组，且其速度慢，其中ＧＢＥＦｍａｘ分别为６４．８％±１８．２％与７７．７％±１６．１％，Ｐ＜０．００１。ＦＤ组３０例（３３．０％）胆囊排空功能低下者经西沙必利治疗后胆囊排空功能改善，ＧＢＥＦｍａｘ由４９．２％±１９．４％增为６３．３％±１２．４％，Ｐ＜０．０１。治疗后患者症状明显减轻。结论研究表明约１／３的ＦＤ患者胆囊排空功能低下，西沙必利可改善此类患者的症状及胆囊功能。     

替勃龙与西沙必利对绝经期功能性消化不良患者胃肠动力的影响

目的　比较替勃龙和西沙必利对绝经期功能性消化不良 (MPFD)患者胃肠动力的影响。方法　 5 3例MPFD和 31例伴胆汁反流的MPFD患者随机分为 3组 ,分别给予替勃龙、西沙必利及替勃龙 +西沙必利治疗 4周。观察胃排空、血浆胃动素和胃内胆汁变化。结果　 3组治疗后胃 30min排空率均增加 (P <0 0 5 ) ,组间差异无显著性。 3组空腹血浆胃动素治疗前后及组间差异无显著性 ;替勃龙和西沙必利均减少胆汁反流 ,两者联合无增强。结论　替勃龙和西沙必利均能改善MPFD患者胃排空 ,减少胆汁反流     

Evaluation of gastric emptying and motility in diabetic gastroparesis with magnetic resonance imaging: effects of cisapride

OBJECTIVE: The motor mechanisms that underlie both slow gastric emptying in diabetic gastroparesis and its acceleration by cisapride are poorly understood. We have recently shown that magnetic resonance imaging (MRI) allows concurrent evaluation of both gastric emptying and regional gastric motility. METHODS: Emptying and motility were measured in eight diabetic patients with previously demonstrated delayed gastric emptying using a rapid MRI technique during oral administration of cisapride and placebo. Studies were performed in a double blind fashion and each patient acted as his own control. Subjects were studied supine for 120 min in a 1.5 Tesla MRI scanner after ingestion of 500 ml of 10% Intralipid. Gastric emptying corrected for the volume of secretions was determined every 15 min using transaxial scans. Each transaxial scan was followed by 120 coronal scans at 1 s intervals. Coronal scans were angled to provide simultaneous imaging of the proximal and distal stomach. MRI studies were also performed in seven diabetic patients with normal emptying who served as disease controls. RESULTS: Emptying was slower in the gastroparetic patients (t(1/2): 124 +/- 10 min) compared to patients with normal emptying (81 +/- 9 min, p < 0.05). Cisapride accelerated gastric emptying (74 +/- 5 vs 124 +/- 10 min) in patients with gastroparesis. The contraction amplitudes in the proximal stomach of gastroparetic patients were increased during cisapride treatment (17.2% +/- 1.8% vs 13.2% +/- 0.6%; p < 0.02), whereas antral contraction frequency, amplitude, and velocity were unchanged. CONCLUSIONS: We conclude that cisapride-induced acceleration of liquid gastric emptying in diabetic gastroparesis does not appear to result from changes in antral contractility, but may be related to changes in proximal gastric tone or gastric outlet resistance.     

Electrogastrography in patients with gastroparesis and effect of long-term cisapride

Abnormalities in the gastric pacemaker potentials occur in patients with impaired gastric emptying. It is unclear if treatment effects the underlying rhythm or if normalization of dysrhythmias is important. We examined the effect of cisapride using surface electrogastrograms and radionuclide gastric emptying studies of patients with idiopathic and diabetic gastroparesis. Twelve of 14 patients had abnormal baseline electrogastrograms. After six months of cisapride, four patients had normalization of their electrical activity and six had improvement. Patients with idiopathic gastroparesis had an increase in gastric emptying at 120 min from 48.9±3.8% (baseline) to 70.9±6.0% (six months), P =0.009. Patients with diabetes mellitus had a similar improvement. Patients who had normalization of the electrogastrogram had a greater gastric emptying rate than patients with continued dysrhythmias. Thus, dysrhythmias are important in the etiology for gastroparesis, but other factors need to be examined.This work was in part supported by the Measey Foundation, by NIH grant R01-DK389641-01 A1, and by the Janssen Research Foundation.     

Antral motility in patients with gastric ulcer

Summary Quantitative analysis of antral motility in patients with gastric ulcer revealed a significant decrease in rhythmic propulsive Type II contractions. After healing of the ulcer, the motility patterns returned to normal. When the antrum was distended, the motor response in ulcer patients was similar to that of healthy volunteers.Supported in part by Research Grant AM-06908 from the National Institutes of Health, U. S. Public Health Service.     

Effect of cisapride on gastric emptying in dyspeptic patients

The effect of the new gastrokinetic agent cisapride on gastric emptying was evaluated in 17 dyspeptic patients using the dual radionuclide technique. Eight patients with idiopathic dyspepsia and nine postsurgical dyspeptic patients were studied and compared to a control group. Gastric emptying of solids and liquids was determined after ingestion of a standardized meal using^99mTc-sulfur colloid scrambled eggs as the solid phase and [¹¹¹In]DTPA-labeled water as the liquid phase. Following a basal study and on a separate occasion, each patient received an intravenous bolus of 10 mg of cisapride after ingestion of the test meal; 10 of the patients were restudied after a two-week period of chronic oral administration of the drug (10 mg four times a day). Baseline gastric emptying of solids was significantly delayed in idiopathic and postsurgical patients; liquid emptying was only delayed in the postsurgical group. Intravenous and oral administration of cisapride significantly shortened gastric emptying in both groups. In all but one patient, the clinical improvement was confirmed by the test. Cisapride appears to be a good alternative to metoclopramide and domperiodone in the treatment of dyspeptic patients. The dual radionuclide technique appears to be a useful physiologic tool for evaluating and predicting the efficacy of a gastric prokinetic therapy in man.