强力抑酸剂对人胃胆囊动力的影响及其相关机制研究

Effects of Potent Acid Inhibition on the Gastric and Gallbladder Emptying in Man: Its Possible Mechanisms

本文采用核素胃排空法及胆囊超声法观察了短期服用奥美拉唑(20mg/日,7天)对正常人与反流性食管炎患者胃,胆囊排空的影响。结果显示,用药后正常组和反流组餐后2小时胃排空率分别从64.1±7.6％和68.0±4.5％降至28.9±6.4％和29.8±5.5％(P值均<0.001),胆囊最大排空率也分别从89.4±1.7％和74.7±1.9％降至65.6±4.7％和50.5±5.0％(P值也均<0.001),胆囊持续收缩排空的时间明显缩短。进一步的研究表明,用药后基础和餐后的SST、VIP、CCK水平无明显改变,但餐后PP释放显著减少(P<0.05)。抑酸后血浆PP释放显著减少,说明迷走胆碱能神经张力下降,可能是胃、胆囊动力改变的重要原因之一,我们认为强力抑酸不宜长期单独用于反流性食管炎治疗,与促动力药物合用比较合理。

In order to verify the effects of potent acid inhibition on the gastric and gallbladdermotility, we examined the scintigraphic gastric and Ultrasonographic gallbladder emptying in healthy subjects (HS) and reflux esophagitis (RE) patients. Results: The results indicated that gastric emptying and gallbladder motility decreased significantly after use of omeprazole (Ome). The maximal gastric emptying rate was reduced from 64.1 ±7.6% to 28.9 ± 6.4% in HS and 68.0±4.5% to 29.8±5.5% in RE patients (P<0.001), and the maximal gallbladder emptying rate was reduced from 89.4 ± 1.7% to 65.6 ± 4.7% in HS and 74.7 ± 1.9% to 50. 5 ±5.0% in RE patients (P<0.001). Ome did not cause obvious alteration of the serum concentration of SST, VIP and CCK, however, postprandial PP release was reduced greatly (P<0.05). It is suggested that the reduced vagal tone may be responsible for the delayed gastric and gallbladder emptying. Conclusion: long-term potent acid inhibition should not be used singly in RE patients, and combined therapy with prokinetic drugs may be a reasonable choice.