莫沙比利联合穴位针刺治疗糖尿病胃轻瘫的临床疗效观察

目的探讨莫沙必利联合穴位针刺治疗糖尿病胃轻瘫的临床疗效。方法 182例确诊为糖尿病胃轻瘫患者随机分为3组,给予莫沙必利治疗62例、单纯穴位针刺治疗54例、莫沙必利联合穴位针刺治疗66例,3组均治疗8周,随访1年,观察临床疗效及临床症状复发情况并进行比较分析。结果莫沙必利联合穴位针刺治疗糖尿病胃轻瘫疗效明显优于单用莫沙必利和穴位针刺组,而且临床症状复发率明显低于其它2组,两项比较均具有统计学意义（P〈0.05）。结论莫沙必利联合穴位针刺治疗糖尿病胃轻瘫具有较好的近期疗效与远期疗效,是值得选择和推广的治疗方法。     

莫沙比利联合针刺治疗糖尿病性胃轻瘫32例

[目的]观察莫沙比利联合针刺治疗糖尿病性胃轻瘫的疗效。[方法]92例患者随机分为3组,A组30例予莫沙比利片口服,B组30例予针刺治疗,C组32例予莫沙比利片配合针刺治疗。疗程均为21d,观察比较疗效。[结果]C组总有效率90．62％,明显高于A组的70．00％和B组的63．33％（均P〈0．05）,A、B组之间差异无统计学意义。[结论]莫沙比利联合针刺治疗糖尿病性胃轻瘫疗效优于单独使莫沙比利及单用针刺治疗。     

莫沙必利联合保和丸治疗糖尿病胃轻瘫38例

目的 观察莫沙必利联合保和丸治疗糖尿病胃轻瘫(DG)的疗效.方法 将9例DG患者随机分为3组:治疗组38例,给予莫沙必利片5 mg,每日3次,联合保和丸6 9,每日2次;对照组①:33例,单用莫沙必利5 mg/次,每日3次;对照组②:28例,单用保和丸6 9,每日2次.疗程均为1个月.疗程结束后观察并记录3组临床症状的变化.结果 3组总有效率分别为;治疗组92.1％,对照组①:75.8％;对照组②:75％.治疗组莫沙必利联合保和丸能有效改善DG的临床症状,增强胃动力,促进胃排空,与对照组比较差异有统计学意义(P＜0.05).结论 莫沙必利联合保和丸有改善DG患者胃动力的作用,临床上可推广应用.     

六君子汤联合莫沙必利治疗糖尿病胃轻瘫的效果研究

目的对六君子汤联合莫沙必利应用于糖尿病胃轻瘫临床治疗中的效果进行分析研究。方法选取于2013年8月—2015年1月期间在该院接受治疗的糖尿病胃轻瘫患者89例,并随机分为对照组(43例)和实验组(46例),观察莫沙必利与六君子汤联合莫沙必利的效果并进行比较。结果实验组患者的治愈率为58.7%,治疗总有效率为91.3%,显著高于对照组患者的23.3%和72.1%;实验组患者的不良反应发生率为8.7%,复发率为6.5%,均显著低于对照组患者的27.9%和25.6%;同时实验组患者的胃固体的排空时间显著短于对照组,差异有统计学意义(P0.05)。结论六君子汤联合莫沙必利应用于糖尿病胃轻瘫临床治疗中的效果十分显著,安全有效,值得大力推广。     

弥可保联合莫沙必利治疗胃轻瘫30例临床观察

应用弥可保联合莫沙必利治疗糖尿病胃轻瘫30例。结果：二周后症状均有不同好转，三个月后无一例复发。胃镜显示胃滞留液减少，蠕动增加，x线钡餐显示钡剂滞留时间〈4h。结论：弥可保与莫沙必利联用可有效治疗糖尿病胃轻瘫并减少复发。     

莫沙比利配合针灸治疗糖尿病性胃轻瘫疗效分析

糖尿病性胃轻瘫(diabetic gastroparesis，DGP)是糖尿病慢性合并症之一，除具有糖尿病本身固有的症状外，兼有早饱、餐后上腹部饱胀、恶心、发作性干呕或呕吐、大便异常等消化系统反应的症状。DGP不仅发生在胰岛素依赖型患者当中，非胰岛素依赖型患者也可并发此病。糖尿病患者当中，约1／3～1/2的病人合并有胃轻瘫。DGP的治疗，在积极控制血糖的基础上，一般应配合使用促胃肠动力药物。临床上较常用西药有胃复安、红霉素、吗丁啉、西沙必利等，但其疗效不稳定，尤其是在停药之后容易复发。我们在使用胰岛素或口服降糖药治疗基础上，观察了莫沙比利配合针灸治疗糖尿病胃轻瘫的疗效。     

弥可保联合莫沙必利治疗胃轻瘫30例临床观察

应用弥可保联合莫沙必利治疗糖尿病胃轻瘫30例。结果：二周后症状均有不同好转，三个月后无一例复发。胃镜显示胃滞留液减少，蠕动增加，x线钡餐显示钡剂滞留时间〈4h。结论：弥可保与莫沙必利联用可有效治疗糖尿病胃轻瘫并减少复发。     

枸橼酸莫沙必利分散片治疗糖尿病胃轻瘫的疗效观察

目的探讨枸橼酸莫沙必利分散片治疗糖尿病胃轻瘫的疗效观察。方法选取2011年9月—2012年9月来该院治疗的糖尿病胃轻瘫患者84例,随机分为两组,实验组42例给予枸橼酸莫沙必利分散片治疗,3次/d,10 mg/次,连续服用10 d;对照组42例则采用潘托拉唑钠肠溶胶囊治疗,1次/d,40 mg口服。结果实验组采用枸橼酸莫沙必利分散片治疗糖尿病胃轻瘫的总有效率为92.9%明显高于对照组采用枸橼酸莫沙必利分散片治疗的总有效率为61.9%,两组患者疗效差异有统计学意义(P<0.05)。其中实验组出现早饱、腹胀、嗳气等症状的发生率为不良反应发生率为7.14%,对照组的不良反应发生率为21.43%,实验组明显少于对照组,差异有统计学意义(P<0.05)。结论使用枸橼酸莫沙必利分散片治疗糖尿病胃轻瘫具有较好的疗效,相比较潘托拉唑钠肠溶胶囊治疗,不良反应少,疗效好的优点,因此值得临床推广。     

莫沙比利并六味能消胶囊治疗胃轻瘫观察

72例糖尿病胃轻瘫患者随机分为2组，36例治疗组口服莫沙比利加六味能？肖胶囊，36例对照组口服莫沙比利口服治疗，疗程均为30天，观察治疗前后胃轻瘫症状改变及上消化道钡餐透视情况。结果：治疗组显效率为47．2％，总有效率为88．9％，对照组显效率为27．8％，总有效率为66．7％。结论：莫沙比利和六味能消胶囊联合优于单用莫沙比利治疗糖尿病胃轻瘫，且副作用小，服用方便，值得临床推广。     

α-硫辛酸联合莫沙必利治疗糖尿病胃轻瘫的临床疗效观察

目的探讨α-硫辛酸联合莫沙必利治疗糖尿病胃轻瘫的临床疗效。方法选取2013-05~2015-06该院就诊的糖尿病胃轻瘫患者70例,随机分为观察组和对照组各35例。在治疗糖尿病的基础上,对照组给予口服莫沙必利,观察组给予α-硫辛酸联合莫沙必利治疗,疗程均为14 d,对比分析两组患者的临床治疗效果。结果两组患者治疗前的胃动素水平及胃排空率对比差异无统计学意义(P0.05)。治疗后两组患者的胃动素水平均比治疗前明显下降,胃排空率均比治疗前明显增高;且观察组的胃动素水平显著低于对照组,胃排空率高于对照组,差异有统计学意义(P0.05)。观察组患者显效20例,有效13例,无效2例。对照组显效14例,有效12例,无效9例。观察组的疗效明显优于对照组(P0.05)。结论α-硫辛酸联合莫沙必利治疗糖尿病胃轻瘫临床疗效较好,有效调节胃肠激素,增强患者的胃排空率,降低胃动素水平,改善患者糖尿病胃轻瘫症状,提高患者的生存质量,值得在临床上广泛应用。     

糖尿病胃轻瘫的治疗进展

糖尿病胃轻瘫(DGP)是糖尿病常见的并发症,发生率达50%～76%,主要表现为胃排空延缓,临床可见厌食、恶心、早饱、呕吐、腹胀等症状,严重影响患者的生活质量和血糖的控制.目前DGP的发病机制尚未明确,可能与自主神经病变、精神心理因素等有关.DGP的治疗方法较多,包括基础治疗、血糖控制、药物治疗、营养支持、胃电起搏、手术及心理治疗等.本文就上述治疗方法在DGP治疗中的最新研究进展作一综述.     

Xiangshaliujunzi Decoction for the treatment of diabetic gastroparesis: A systematic review

AIM:To assess the current clinical evidence of the effectiveness of Xiangshaliujunzi Decoction(XSLJZD)for the treatment of diabetic gastroparesis(DGP).METHODS:Randomized controlled trials(RCTs)were retrieved from seven major electronic databases including Medline,the Cochrane Library,Embase,Chinese Biomedical Literature Database(CBM),Chinese National Knowledge Infrastructure,Chinese Scientific Journal Database(VIP),and Wanfang Databases,using search dates from the beginning of the databases to May 2013.No language limitations were applied.We included RCTs that used XSLJZD or a modified XSLJZD compared with a control group for the treatment of DGP.The control groups included conventional treatment(Western medicinal treatment),placebo,and no treatment(blank),but not acupuncture.The main outcome index was clinical effectiveness,which was based on the gastric emptying test and variations in the gastrointestinal(GI)symptoms between the treatment and control groups after intervention.Data extraction,analysis,and quality assessment were conducted according to the Cochrane Handbook for Systematic Review of Interventions,Version 5.1.0.RESULTS:Ten RCTs involving 867 patients(441 in the experimental groups,and 426 in the control groups)were identified,and the overall methodological quality was evaluated as generally low.In the treatment groups,all 10 trials used herbs alone as the treatment,whereas all control groups used prokinetic medicine.The period of intervention ranged from 2 to 8 wk.Three classes were used to evaluate treatment efficacy:significant effective,effective,and ineffective,and all trials used the clinical effective rate(based on the gastric emptying test and changes in GI symptoms)to evaluate efficacy.The data showed that the effects of XSLJZD for the treatment of DGP were superior to the control group(n=867,RR=1.33,95%CI:1.24-1.42,Z=8.11,P<0.00001).Two trials recorded adverse events,and one trial reported follow-up.CONCLUSION:XSLJZD could restore the gastric emptying rate and improve symptoms.However,the evidence remains weak due to the poor methodological quality of the included studies.     

Metoclopramide for the treatment of diabetic gastroparesis

ABSTRACT

Introduction: Gastroparesis is a chronic disorder of the stomach characterized by delayed gastric emptying without mechanical obstruction. Diabetes is the most commonly known cause of gastroparesis. Management of diabetic gastroparesis involves lifestyle modifications, glycemic control, pharmacological drugs, and for refractory cases surgical treatments. Metoclopramide remains the only drug approved by the Food and Drug Administration for diabetic gastroparesis. The aim of this article is to provide a concise review of the pharmacology, clinical efficacy and tolerability of metoclopramide.

Areas covered: We searched PubMed using the key words ‘metoclopramide’, ‘diabetic gastroparesis’, and ‘gastric emptying’. The relevant articles and their bibliography were reviewed. Metoclopramide acts on several different receptors; primarily as a dopamine receptor antagonist, both peripherally improving gastric emptying, and centrally resulting in an anti-emetic effect. Metoclopramide side effects, mostly related to its ability to cross the blood-brain barrier, include drowsiness, restlessness, hyperprolactinemia, and tardive dyskinesia (TD), a movement disorder that may be irreversible.

Expert opinion: Metoclopramide carries a black box warning for use >12 weeks due to the risk of TD. However, gastroparesis patients experience chronic symptoms often requiring prolonged treatments. Physicians and patients look forward to FDA approval of new agents for gastroparesis with better efficacy and safety profile.     

Prospective evaluation of gastric neurostimulation for diabetic gastroparesis in Canada

BACKGROUND:

The efficacy of gastric neurostimulation therapy for diabetic gastroparesis (GP) in a ‘real-life’ Canadian setting has not been assessed.

AIMS:

To assess changes in health-related quality of life (QoL), weekly vomiting frequency (WVF), total symptom score (TSS) and health care utilization 12 months before and after gastric neurostimulator implantation in a diabetic GP cohort.

METHODS:

Medication-refractory diabetic GP patients (n=7, four female, mean age 42 years) were prospectively recruited from 2008 to 2012. QoL scores were self-administered and obtained at baseline, 24 and 48 weeks postimplantion. WVF and TSS were assessed similarly. Health care usage, measured as hospitalization frequency and medication cost, was obtained six and 12 months before and after implant. Changes from baseline to six and 12 months for all outcomes were compared.

RESULTS:

The mean (± SD) QoL according to EuroQol was significantly better at 24 weeks after the baseline measurement (baseline 29±5, 24 weeks 52±7; P=0.03). The mean improvement in TSS was significantly better at one year postintervention (baseline score 35±5 versus 12 months 27±3; P=0.03). Changes in Short-Form 36 Health Survey and WVF were not significant. Days of GP-related hospitalization were highly variable but decreased from a median of 71 days (range 0 to 227 days) to 29 days (range two to 334 days) one year before and after surgery, respectively (P=0.735). Outpatient medication costs did not decrease to a significant extent.

CONCLUSION:

Gastric neurostimulation for diabetic GP appeared to show some beneficial palliative effects overall in the present small open-label series, but the effect is highly variable among patients, and placebo effect cannot be ruled out.     

胃起搏治疗胃动力障碍性疾病的临床疗效观察

目的探讨胃肠起搏器治疗胃动力功能障碍性疾病的临床疗效。方法将60例胃动力障碍性疾病患者随机分为起搏器组和西沙比利组2组,前组给予起搏器治疗,1次/日,30分钟/次;后组给予口服西沙比利5mg,3次/天,共20天。治疗前后分别观察症状积分变化,并记录胃电频率、正常及异常胃电节律百分比等胃电参数。结果两组患者治疗前后症状评分比较均有显著性差异,起搏器组在改善嗳气、早饱等症状方面优于西沙比利组(P<0.05),但两组症状总积分比较无显著性差异(P>0.05);两组中除西沙比利组对空腹胃电频率改善不明显外,其它治疗前后比较均有显著性差异(P<0.05);虽然两组治疗后对正常胃电频率百分比均有明显提高(P<0.05或P<0.05),但起搏器组比西沙比利组更明显,两组比较有显著性差异。结论胃肠起搏器可明显改善胃动力功能障碍性疾病的症状及胃电参数变化。     

糖尿病胃轻瘫的诊断及发病机制

目的:探讨糖尿病胃轻瘫的早期诊断方法并探讨其可能的发病机制.方法:糖尿病住院患者38例,采用生化及放射免疫方法检测血糖、糖化血红蛋白、胃动素、胃泌素、胰高血糖素水平.以患者卧立位肱动脉收缩压变化检查植物神经功能;并采用标准餐加服小钡条试验,记录排空时间,以胃排空时间＞6 h诊断为胃轻瘫.结果:糖尿病胃排空异常者与胃排空正常者相比其空腹血糖(12.53±4.13 mmol/L vs 7.12±1.37 mmol/L,P＜0.01)、餐后血糖(19.79±5.69 mmol/L vs 14.11±4.21 mmol/L,P＜0.05)及糖化血红蛋白(9.73%±2.39% vs 7.26%±1.96%,P＜0.05)明显升高,同时具有高水平的血清胃动素、胃泌素及胰高血糖素.糖尿病胃排空异常者植物神经功能异常发生率为62%(13/21),而糖尿病胃排空正常者为24%(4/17),糖尿病胃排空异常者胃内小钡条排空时间较正常者明显延长(7.93±1.23 h vs4.35±1.01 h,P＜0.001).结论:采用临床症状评分、血糖及胃肠道激素等监测及影象学检查可诊断糖尿病胃轻瘫,糖尿病胃轻瘫与神经病变、高血糖、血清胃肠激素异常、微血管病变及代谢紊乱有关.     

Novel surgical treatment and gastric pathology in diabetic gastroparesis.

AIMS: Observations are made on four Type 1 diabetic patients with the rare syndrome of intractable vomiting from confirmed gastroparesis, to determine whether radical surgery would alleviate their symptoms and subsequently to examine in detail the gastric histopathology. METHODS: The surgical approach consisted of an approximate 70% resection of the stomach, including the antrum and pylorus, with closure of the duodenum and restoration of gastrointestinal continuity with a 60-cm Roux-en-Y jejunal loop. Four longstanding Type 1 diabetic patients were examined and treated as described. They were all women in the age range 2741 years with grossly abnormal autonomic function tests in whom other causes for gastric paresis had been excluded. RESULTS: Vomiting episodes leading to multiple hospital admissions (6-8) in the year preceding surgery were eliminated in three of the four patients, while in the fourth initial success was followed by the need for dialysis for renal failure. Gastric histopathology showed evidence of smooth muscle degeneration and fibrosis, with eosinophilic inclusion bodies (M-bodies) which appear to be unique to this condition. The findings suggest the presence of a gastromyopathy. CONCLUSIONS: Satisfactory relief of intractable vomiting from diabetic gastroparesis was achieved by a novel radical surgical procedure. Histopathological findings suggest that gastromyopathy may contribute to the production of this syndrome.     

Emerging strategies for the treatment of gastroparesis

Gastroparesis is a syndrome of delayed gastric emptying in the absence of mechanical obstruction. Symptoms can be debilitating, affect nutritional states, and significantly impact patients’ quality of life. The management of these patients can prove quite difficult to many providers. This article will review the current management recommendations of gastroparesis, discuss investigational medications and interventions, and summarize future directions of therapies targeting the underlying disease process. Current therapies are subdivided into those improving gastric motility and those directly targeting symptoms. Non-pharmacologic interventions, including gastric stimulator implantation and intra-pyloric botulinum toxic injection are reviewed. A discussion of expert opinion in the field, a look into the future of gastroparesis management, and a key point summary conclude the article.     

糖尿病胃轻瘫大鼠胃窦内ICC和SP变化的实验研究

目的观察Cajal间质细胞和P物质在糖尿病胃轻瘫大鼠胃窦的改变,进而探讨糖尿病胃轻瘫发生的相关机制。方法SD大鼠30只,随机分为正常对照组（n=10）和糖尿病组（n=20）。用链脲佐菌素建立大鼠糖尿病胃轻瘫模型,3个月后用放射性核素（^99Tc）灌胃测定大鼠胃液体排空率,取正常对照组及模型组大鼠胃窦标本,应用免疫组化染色法检测c—kit阳性Cajal间质细胞和P物质在大鼠胃窦的变化,应用彩色病理图像分析软件进行分析,并行统计学比较。结果与正常大鼠相比,糖尿病大鼠胃排空明显延迟（P〈0．01）,胃窦c—kit阳性Cajal间质细胞减少（P〈0．01）,P物质表达减少（P〈0．01）。结论糖尿病胃轻瘫与Cajal间质细胞和P物质的变化有一定的相关性。