顺铂相关消化不良中胃肌电活动的作用

Cisplatin-associated dyspeptic symptoms with exception of vomiting do not follow abnormal gastric myoelectrical activity in canine

目的探讨胃肌电活动在顺铂相关消化不良(cisplatin-associated dyspepsia)中的作用。方法于7条比格犬的胃大弯前壁浆膜层植入4对心脏起搏电极。静脉输入顺铂(1mg/kg),1h内匀速输完。根据顺铂呕吐潜伏期,分为20min(基线期),0～1h(给药期间),1～3.5h(呕吐前),3.5～5h(呕吐期间)等4个不同实验时间段。在相应时间段,分别观察出现的消化不良症状并评分,同时记录其间的胃慢波。软件自动分析及肉眼判断呕吐前后胃慢波变化。结果①全部实验犬均出现反复呕吐,平均呕吐次数6·71±2.56,呕吐潜伏期154.71±4.99min,呕吐持续时间80.57±14.79min。②与基线期相比,顺铂输入期间(0～1h)无明显消化不良症状,但在输入后的1～3.5h、3.5～5h逐渐增多。③3.5～5h胃慢波与基线期的胃慢波比较,正常胃慢波百分率明显降低,主功降低,主频无明显变化。而20min、0～1h、1～3.5h之间的正常胃慢波百分率、主频、主功的改变无统计学差异(P>0·05)。④呕吐过程中出现小于1min的呈荆棘样波形的胃电过速,其前后均出现持续时间小于1min的胃电过缓,随之在1min内恢复正常。结论除呕吐具有短暂特征性胃慢波改变之外,顺铂诱发的其余消化不良症状无明显胃肌电改变。胃肌电改变可能不是顺铂相关消化不良的主要发病原因。

Objective To investigate the relationship between gastric myoelectrical activity and cisplatin -associated dyspeptic symptoms in canine. Methods Seven female beagles chronically implanted four pairs of cardiac electrodes along the greater curvature of stomach in gastric sera were intravenously infused with cisplatin （lmg/kg）. And based on the latency of vomiting, the experiment was artificially divided into four continuous periods, 20rain before cisplatin infusion, 0 lh during cisplatin infusion, 1 ～ 3.5h （ latency of vomiting） and 3.5 ～5h （ vomiting appeared ） after eisplatin infusion. The recording of gastric slow wave （GMA） and the score of dyspeptic symptoms occurred during the four sessions were couected. Computerized spectral analysis and visual analysis were applied to detect the GMA change during various periods before and after vomiting. Results ① Recurrent vomiting could be observed in all dogs, the average numbers of vomiting were 6.71 ±2.56 times, the average latency of time was 154.71 ±4.99min, the average time between the start and the disappearance of vomiting was 80.57± 14.79 rain. ② Compared with 20 min session, 0 ～1h session did not present with noticeable dyspeptic symptoms. But these dyspeptic symptoms increased significantly during 1 ～3.5h session and 3.5 ～ 5h session, and reached peak in 3.5 - 5h session. ③ Percentage of normal gastric slow wave and dominant power were lower in 3.5 ～ 5h session than that in 20min session. However, dominant frequency, between the two session was similar. In spite of this, among the 20rain session, 0 -1h session and 1 ～3.5h session, no significantly different percentage of gastric slow wave, dominant frequency, and dominant power were seen. ④ Gastric slow wave exhibited the brief duration of dysrhythmias during the period of vomiting. Bradygastria（ 〈 1 min） began firstly. Then tachygastria resembling jungles included a series of pulses with characteristics of low amplitude and short width appeared （ 〈 1min）. After that, recurrence of bradygastria （ 〈 1min） emerged before normal gastric wave appared. Conclusions Cisplatin - associated dyspeptic symptoms, with the exception of emesis, do not respond to abnormal gastric myoelectrical activity, suggesting that abnormal gastric myoelectric activity is not a determining factor in the pathogenesis of eisplatin-associated dyspepsia.