消化间期移行性复合运动产生的机制和临床意义

消化间期移行性复合运动产生的机制和临床意义张建忠王雁袁申元在消化间期胃及小肠运动表现为一种规律的周期性的收缩活动，这种收缩活动一般起源于胃窦或十二指肠，向离口方向传播，并可达结肠近端。表现为静息和运动循环往复的空腹运动类型，称为消化间期移行性复合运动...     

胆酸、小肠消化间期移行性复合波与胆固醇结石的关系

胆酸理化特性、代谢特性影响胆固醇结石形成。但同时在消化间期 ,胆酸肝肠循环作为结石形成的动力因素 ,可通过影响小肠消化间期移行性复合波 (MMC)和胆囊运动 ,以脱氧胆酸为中介 ,促进致石胆汁形成 ,提高结石发生率。胆固醇结石胆囊切除术改变胆酸池体积、胆酸肝肠循环和小肠MMC。     

实验性急性肝内胆汁淤积幼年大鼠胃肠消化间期移行性肌电复合波的变化

目的:探讨异硫氰酸萘酯(ANIT)所致刚断乳大鼠急性肝内胆汁淤积胃肠消化间期移行性肌电复合波(MMC)的变化.?方法:?56只刚断乳SD大鼠被随机分为正常对照组(n?=?16)、中毒组(n?=?40).?两组分别随机取8只在胃窦、十二指肠、空肠分别慢性埋置三对银丝电极;?其余大鼠同时行假手术.?术后7-10?d,?埋置电极组大鼠均在清醒、空腹、自由活动状态下记录胃肠道MMC.?中毒组按200?mg/kg一次性灌服ANIT诱发大鼠急性肝内胆汁淤积病变,?观察灌服ANIT后中毒组在48,?96,?144,?192?h胆汁流量、血中TB和ALT值及胃肠MMC的变化.?结果:中毒组灌服ANIT后,?48?h时胆汁流量中断,?血清TB和ALT明显升高;?48?h后其胆汁流量逐渐增加,?血清TB和ALT逐渐下降,?于192?h基本恢复.?在ANIT灌胃前,?埋置电极的所有大鼠在清醒、禁食状态下均记录到典型的MMC节律性电活动,?正常对照组与中毒组之间差异无显著性意义;?中毒组灌服ANIT后,?MMC节律完全消失,?代之以Ⅱ期样节律紊乱波;?144?h后,?中毒组MMC节律运动开始恢复;?192?h时中毒组MMC均为节律运动,?但中毒组MMC持续时间(911.67±140.47?s)较正常对照组(682.87±77.39?s)明显延长,?其中主要是Ⅱ期持续时间延长(414.12±69.21?vs?150.28±35.45?s),?而Ⅲ期持续时间略缩短(121.21±27.38?s?vs?170.27±38.98?s)?,?差异有显著意义(P<0.05).结论:?急性肝内胆汁淤积时胃肠MMC表现MMC节律短暂消失或MMC周期延长;?其部分原因可能与消化间期胆汁流量减少有关.     

消化间期移行性复合运动的发生机制

探讨消化间期移行性复合运动（ＭＭＣ）发生机制。方法应用胃十二指肠测压技术对３５例ＭＭＣ正常出现者的消化间期胃十二指肠运动的特征进行了研究,并在检测过程中分别于ＭＭＣ１、２、３期采集静脉血测定血浆胃动素（ＭＴＬ）水平。结果在ＭＭＣ１期之后最先出现收缩活动的部位是十二指肠中段和远端,收缩活动的起步点逐渐向胃窦方向转移,并伴随血浆ＭＴＬ水平逐渐升高,当ＭＭＣ３期出现时血浆ＭＴＬ已达到峰值水平,血浆ＭＴＬ水平ＭＭＣ１期为３３４．２６±９５．１０（ｎｇ／Ｌ）,２期为４１５．２２±９１６９（ｎｇ／Ｌ）,３期为５８１６±１２１．６８（ｎｇ／Ｌ,各期之间比较均有显著性差异（Ｐ＜０．０１）。结论ＭＭＣ１期由于存在消化液基础分泌和幽门开放可发生消化液在十二指肠内的聚集,然后通过牵张反射诱发ＭＭＣ２期十二指肠的运动和ＭＴＬ分泌增加,ＭＴＬ分泌增加可能是诱发ＭＭＣ３期产生的重要原因。     

糖尿病患者小肠移行性复合运动的研究进展

小肠消化间期移行性复合运动（migrating motor complex，MMC），是一种化学能转化为机械能的过程，受中枢神经系统、肠神经系统和胃肠激素共同支配与调控。糖尿病患者肠道功能紊乱是与之相关的疾病，异常的小肠MMC与胃肠激素、自主神经和血糖有密切关系，从而影响了糖尿病患者的诊断和治疗。     

尿毒症患者消化间期移行性复合运动规律的变化

消化间期移行性复合运动 (ｍｉｇｒａｔｉｎｇｍｏｔｏｒｃｏｍ ｐｌｅｘ ,ＭＭＣ)是在消化间期和空腹状态下的胃肠基本运动形式 ,其对食物残渣的排空具有重要作用。消化道症状是慢性肾功能不全、尿毒症患者最常和最早出现的临床表现 ,但是尿毒症患者ＭＭＣ规律如何 ?目前国内尚未见报道。本研究对 2 6名尿毒症患者进行了ＭＭＣ测定 ,以探讨尿毒症患者的ＭＭＣ规律。1　对象和方法1.1　研究对象1.1.1　尿毒症组　 2 6人。其中男 11人、女 15人 ,年龄 2 9～ 70 (平均 5 0 9± 10 32 )岁。均符合慢性肾功能不全、尿毒症的诊断 (表 1)。除外…     

急性肝衰竭大鼠消化间期移行性运动复合波的变化特点

目的 观察急性肝衰竭大鼠胃肠消化间期移行性运动复合波(MMC)的变化及其特点. 方法 采用D-氨基半乳糖急性肝衰竭大鼠模型,用多道生理记录仪分别记录正常对照组和急性肝衰竭模型组大鼠的胃肠消化间期MMC,并对两组大鼠胃肠消化间期MMC的各项指标进行比较分析. 结果 大鼠胃窦和十二指肠MMCⅡ相:急性肝衰竭组分别为(1519.00±831.14)s和(1535.86±930.50)s,正常对照组分别为(573.61±409.98)s和(541.09±342.30)s,急性肝衰竭组比正常对照组显著延长,t值分别为-3.97和-3.85,P值均<0.05.大鼠胃窦和十二指肠MMCⅢ相:急性肝衰竭组分别为(23.39±6.36)s和(27.02±11.50)s,正常对照组分别(53.32±14.01)s和(53.81±1 3.64)s,急性肝衰竭组比正常对照组明显缩短,u值分别为-4.99和4.66,P值均<0.05.胃窦Ⅲ相频率:急性肝衰竭组为(0.04±0.01)HZ,正常对照组为(0.22±0.01)HZ,u=-4.73,P<0.05,差异有统计学意义.大鼠空肠MMC周期和MMCⅡ相:急性肝衰竭组分别为(1897.71±815.77)s和(1870.90±1010.35)s,正常对照组分别为(1384.17±449.34)s和(643.04±450.67)s,两组比较,u=-1.63和t=-4.94,P值均<0.05.大鼠空肠MMCⅢ相持续时间:急性肝衰竭组为(31.41土11.17)s,正常对照组为(53.11±14.74)s,t=5.10,P<0.05.大鼠胃窦和十二指肠MMC周期、十二指肠MMCⅢ相频率和空肠Ⅲ相频率变化,两组大鼠比较,差异无统计学意义.结论 急性肝衰竭大鼠MMCⅡ相显著延长,呈移行性簇状收缩,MMCⅢ相缩短,空肠MMC周期延长,可能是导致急性肝衰竭大鼠胃肠动力障碍的主要原因.     

糖尿病患者小肠移行性复合运动的研究进展

小肠消化间期移行性复合运动(migrating motor complex,MMC),是一种化学能转化为机械能的过程,受中枢神经系统、肠神经系统和胃肠激素共同支配与调控。糖尿病患者肠道功能紊乱是与之相关的疾病,异常的小肠MMC与胃肠激素、自主神经和血糖有密切关系,从而影响了糖尿病患者的诊断和治疗。     

消化间期移行性复合运动对胆道调节作用的实验研究

目的 探讨消化间期移行性复合运动(MMC)与胆道运动的相互关系及两者间的相互调节作用，进一步阐明MMC的发生机制，并为胆石症的防治提供理论依据。方法 将45只成年豚鼠分为对照组，普卡比利组和地巴唑组，在胃窦、十二指肠上段、十二指肠中段、胆囊(GB)及Oddi括约肌(SO)等五处肌肉层内埋置银丝电极，用八导生理记录仪记录该部位肌电活动，胃内分别给予普卡比利和地巴唑后，观察肌电变化及MMC与GB、SO运动的关系。结果 各组动物给药前五个记录点的肌电活动频率和强度呈正相关(P＜0．05)。胃肠MMC的肌电活动被普卡比利增强后，GB、SO部位的肌电活动相应地加强。胃肠MMC的肌电活动被地巴唑抑制后，GB、SO部位的肌电活动相应地被抑制(P＜0．05)。结论 胃肠肌电活动的改变能引起胆道肌电活动的相应变化，提示胃肠MMC对胆道运动有调节作用。     

枳实消痞颗粒剂对糖尿病大鼠胃肠激素的影响

目的:探讨枳实消痞颗粒剂对糖尿病大鼠胃肠激素的影响.方法:选择雄性SD大鼠60只,用四氧嘧啶建立糖尿病模型,用枳实消痞颗粒剂每天灌服治疗组大鼠,连续4周,实验结束取血浆测定各鼠胃泌素(GAS)、胃动素(MOT)、胰高糖素及P物质(SP).结果:糖尿病组大鼠GAS和MOT水平低下,与正常组比较均P＜0.05;胰高糖素水平增高,与正常组比较均P＜0.05;SP在各组中表达差异无统计学意义;枳实消痞颗粒剂能提高MOT水平,与模型组比较P＜0.05.结论:糖尿病大鼠GAS、MOT水平低下,胰高糖素水平增高;枳实消痞颗粒剂能提高糖尿病大鼠的MOT水平.     

急性肝衰竭大鼠胃肠运动改变与肠神经元关系研究

目的观察急性肝衰竭大鼠胃肠消化间期移行性复合运动的变化与肠神经元的关系。方法采用D-氨基半乳糖诱导的急性肝衰竭大鼠模型,使用多道生理记录仪记录正常大鼠和急性肝衰竭大鼠的胃肠消化间期移行性复合运动,采用TUNEL法、5-HT和NSE免疫组化法检测空肠神经元的凋亡情况。结果急性肝衰竭大鼠空肠MMC周期较对照组显著延长（1897.71±815.77对1384.17±449.34S,P〈0.05）,尤以Ⅱ期延长为主（1870.90±1010.35S对643.04±450.67S,P〈0.05）,成簇状移行性收缩,Ⅲ期显著缩短（31.41±11.17S对53.11±14.74S,P〈0.05）;急性肝衰竭大鼠肠神经元凋亡明显增多,TUNEL染色阳性细胞核固缩或碎裂,呈棕黄色,细胞大小不一;5-HT和NSE免疫组化检测发现急性肝衰竭大鼠阳性物质表达较正常大鼠减少。结论急性肝衰竭大鼠胃肠MMCⅡ期延长,Ⅲ期明显缩短,导致胃肠动力异常,可能与肠神经元的凋亡有关。     

多种胃肠激素在消化间期移行性复合运动中作用的研究

目的　通过研究胃肠激素与消化间期移行性复合运动(MMC)的关系,探讨 MMC发生及其调节机制。方法　应用胃十二指肠测压技术对30例健康志愿者的消化间期胃十二指肠运动的特征进行研究,并在检测过程中分别于MMCⅠ、Ⅱ和Ⅲ相采集静脉血行胃动素(MTL)、生长抑素(SS)、P物质(SP)及一氧化氮(NO)的血浆浓度检测。结果　MMC周期为112.7 min±37.2 min,MMCⅠ相最长,Ⅱ相次之、Ⅲ相最短,MMCⅢ相多起源于胃窦,也可起源于十二指肠。MMC多向远端移行,偶见逆向传导。MMCⅢ相血浆MTL为921.7 pg/ml±109.8 pg/ml,SP为10.9 pg/ml±7.2 pg/ml,明显多于Ⅰ相(分别为334.7 pg/ml±58.1 pg/ml,11.3 pg/ml±8.8 pg/ml)和Ⅱ相(分别为 370.0 pg/ml±69.2 pg/ml,11.0 pg/ml±10.0 pg/ml),差异有统计学意义(P<0.05)。血浆 SS、NO水平各时相相比差异无统计学意义(P>0.05)。结论　MTL、SP可能与 MMCⅢ相的诱发有关。血浆 SS、NO水平可能对胃肠MMC无直接作用。     

Influence of migrating motor complex on esophageal motility

In most fasting mammals motility of the foregut and small intestine undergoes regular cycles of activity. The phenomenon has been called the interdigestive migrating myoelectric complex or the migrating motor complex. As shown in published literature, feeding interrupts the cycle and changes the interdigestive fasted pattern into a pattern of irregular spiking activity, which has been called the fed pattern. The mapping of the migrating motor complex throughout the upper gut demonstrated major regional variations. The incidence of migrating motor complex at multiple sites from distal esophagus to cecum approximated a normal distribution. In the course of esophageal manometric studies the influence of migrating motor complex on lower esophageal sphincter was observed. This observation raised the question whether future pharmacomanometric studies should be performed with volunteers in the fasting state as done until now. According to published literature, lower esophageal sphincter pressure is significantly higher during migrating motor complex phase III than phase I; differences are approximately twofold. Fifty percent of migrating motor complexes involve the esophagus. The migrating motor complex in some individuals interferes significantly with esophageal pharmacomanometry provided the volunteers are fasted. On the other hand postprandial lower esophageal sphincter pressure was rather constant at a level comparable with that measured in migrating motor complex phase I. The consequences of this phenomenon for the study design in pharmacomanometry are discussed.     

Increase of swallows before onset of phase III of migrating motor complex in normal human subjects

The aim of our study was to analyze the relation between the deglutitive activity and fasting esophageal and gastric motility in normal subjects. Fifteen healthy subjects (9 males, 6 females) with a mean age of 42 years (range 19–65) were studied. A 24-hr pH-manometric recording was performed using a probe with four solid-state recording sites 10 cm apart, placed so as to record the motor activity of esophageal body, lower esophageal sphincter (LES) or distal part of the esophagus, and gastric antrum. An additional probe with one recording site was placed in the pharynx to evaluate swallowing. A pH electrode was also placed at 5 cm above the sphincter. Data were transferred to a personal computer and analyzed using specific software. Subjects received two meals during the recording session. MMCs were almost exclusively recorded during the nighttime. A mean of 2±0.94 (sd) MMC per subject was detected with a mean (±sd) interval, between each cycle, of 86.11±34.53 min. During the 30 min preceding gastric phase III, the number of swallows showed an increase that reached statistical significance 5 min before the onset of phase III. A similar pattern was observed for the area under the curve (AUC) of the esophagus and LES. In conclusion deglutition and esophageal motility vary with the MMC, suggesting that the deglutitive activity is part of the interdigestive motility pattern.     

一氧化氮对小肠消化间期移行性复合运动作用的研究

目的研究一氧化氮（ＮＯ）在小肠消化间期移行性复合运动（ＭＭＣ）控制中的作用。方法在大鼠十二指肠、空肠分别埋置应变片,在动物清醒的状态下分别记录空腹和餐后静脉输注ＮＧ硝基Ｌ精氨酸甲酯（ＬＮＡＭＥ）、Ｌ精氨酸、Ｄ精氨酸、硝普钠和血管紧张素Ⅰ后十二指肠和空肠压力变化。结果在餐后注入一氧化氮合酶抑制剂ＬＮＡＭＥ,可诱发类似空腹状态下的ＭＭＣ运动形式;注入ＮＯ供体硝普钠,则中断空腹时的小肠ＭＭＣ周期,诱发进食后小肠运动形式;Ｌ精氨酸和ＬＮＡＭＥ同时输注,消除ＬＮＡＭＥ的作用,而Ｄ精氨酸无此作用。单独输注Ｌ精氨酸、Ｄ精氨酸或血管紧张素Ⅰ对小肠ＭＭＣ没有影响。结论小肠神经系统ＮＯ紧张性分泌的调节,可能与小肠消化间期和消化期之间小肠运动形式的转换有关,ＮＯ释放增加可导致Ⅱ相时间变长,中断或延长ＭＭＣ;抑制ＮＯ合成与小肠消化间期运动形式的产生有关。     

Biliary pressure variation in coordination with migrating motor complex of duodenum in patients with cholecystectomy and effects of morphine and cerulein

Pressures in the common bile duct and duodenum were continuously measured with two pressure microtransducers placed by endoscopy in 10 postcholecystectomy patients. A complete cycle of the migrating motor complex of the duodenum was obtained in seven patients, its length ranging from 62 to 174 min with a mean of 114 min. The biliary pressure showed a transient elevation of 5.0±0.6 (mean±sem) mm Hg (P<0.001) in concert with phase II of the duodenal cycle in all 10 patients, whereas it remained stable during other phases. Intramuscular morphine (0.2 mg/kg) given to induce spasm of the sphincter of Oddi 20 min after the passage of phase II invariably produced an activity front in the duodenum and a sustained increase in the biliary pressure, the magnitude of which was 8.3±0.9 mm Hg. The biliary pressure raised by morphine dropped after an intravenous injection of cerulein (0.1 g/kg) as a sphincter relaxant. These findings indicate that the biliary pressure rises transiently at phase III of the duodenal cycle in patients after cholecystectomy, probably due to contractions of the sphincter of Oddi.