胃肠电生理起搏治疗胃肠动力障碍性疾病的临床疗效

Efficacy of gastrointestinal pacing on gastrointestinal motility disorders

目的 探讨胃肠电生理起搏对胃肠动力障碍性疾病的疗效 ,并探索其可能的作用机制。方法 82例胃肠动力障碍性疾病患者 ,随机分为 2组 ,低频和高频起搏组分别为 5 0和 32例 ,分别采用1 .1～ 1 .2倍内源性胃慢波频率 (IGF)叠加 1 0Hz的双极脉冲方波和 4 .0倍IGF叠加 30Hz双极脉冲方波进行起搏。胃起搏 1次 /d ,每次 4 5min ,共 1 5d。采用 8导联胃电图仪 (EGG)记录患者空腹状态和进食试餐后的胃电活动各 1h。分别于治疗前、治疗 1 5d后对胃电图和各种症状的改善情况进行评估。结果 治疗 1 5d后 ,除高频起搏组反酸外 ,患者各症状评分均有改善 ,差异有显著性 (P <0 .0 4 )。高频起搏组治疗后恶心、呕吐的改善较低频起搏组更为明显 (P <0 .0 5 ) ,而低频起搏组早饱、嗳气的缓解则较高频起搏组更显著 (P <0 .0 5 ) ,但两组间症状总积分的比较差异无显著性 (P >0 .0 5 )。治疗后低频起搏组餐后过速频率较治疗前显著降低 [(3.4 3± 0 .2 5 )次 /min比 (3.0 1± 0 .2 0 )次 /min ,P <0 .0 5 ],餐后过缓频率则显著增加 [(2 .4 1± 0 .4 3)次 /min比 (2 .6 7± 0 .2 6 )次 /min ,P <0 .0 5 ]。但无论在空腹状态或餐后 ,高频起搏组治疗前后其胃电主频率无明显改变 (P >0 .0 5 )。

Objective To investigate the effects of surface gastric pacing on gastrointestinal(GI) motility disorders and to explore its underlying mechanism. Methods Eighty two patients with GI motility disorders were randomly divided into two groups, 50 patients in group of low frequency gastric pacing with a 1.1～1.2 times the intrinsic physiologic slow wave frequency (IGF) superimposed with high frequency pulses of 10 Hz , and 32 patients in group of high frequency gastric pacing with 4.0 times IGF superimposed with a high frequency pulses of 30 Hz. Surface gastric pacing was performed for 45 min after meal once daily for 15 d. Gastric myoelectrical activity was measured by surface eight channel electrogastrograpy (EGG) for 1 hour in the fasting state and 1 hour after a test meal. Dyspepsia symptoms were evaluated before and 15 d after treatment. Results After treatment all the symptoms except for regurgitation in high frequency group had improved, and symptom scores were significantly lower than those before therapy ( P <0.04). The severity and frequency of nausea and vomiting in high frequency group were less than those in low frequency group( P < 0.05 ), and the severity and frequency of belching and early satiety in low frequency group were less than that with high frequency( P < 0.05 ).However, there were no significant differences in total symptom scores (TSS) between two groups( P > 0.05 ). After low frequency gastric pacing, the frequency of tachygastrias was significantly decreased(3.43 cycles/min±0.25 cycles/min vs. 3.01 cycles/min±0.20 cycles/min, P < 0.05 ), While the frequency of bradygastrias was significantly increased(2.41 cycles/min±0.43 cycles/min vs. 2.67 cycles/min±0.26 cycles/min, P < 0.05 ). However, in high frequency group, there were no signi ficant differences in gastric dominant frequency after gastric pacing( P > 0.05 )in both fasting and fed states . After treatment, the percentage of regular gastric slow waves was remarkably increased in each group( P < 0.003 ), whereas gastric myoelectrical abnormalities in low frequency group was much more improved than that in high frequency group( P < 0.05 ). Conclusions GI pacing had shown to improve dyspepsia symptoms and the EGG parameters in patients with gastric motility disorders significantly, and to modulate gastric dysrhythmia bi directionally. The therapeutic efficacy of surface GI pacing correlated with pacing parameters. Low frequency gastric pacing might have more significant role in regulating gastric rhythmicity than high frequency gastric pacing.