不同阶段糖尿病胃运动障碍诊治对策

Diagnostic and Therapeutic Strategies of Gastric Motility Disorder in Different Stages of Diabetes

糖尿病患者常见胃运动障碍,表现为上腹胀、早饱、上腹不适、恶心、呕吐等症状以及胃排空延迟,胃排空延迟影响降血糖药的药代动力学,造成餐后血糖升高与降血糖药或胰岛素的血浓度高峰不匹配,进而影响血糖的控制与稳定。糖尿病不同阶段胃运动障碍表现形式不同。核素法是最常用的胃排空诊断方法。糖尿病胃运动障碍的处理包括饮食调节、促动力药以减轻症状、控制血糖,针对胃轻瘫的治疗包括胃电刺激、内镜下幽门注射肉毒杆菌毒素A、内镜下放置鼻胃空肠营养管或经皮内镜下胃(空肠)造瘘、外科手术等。

Gastric motility disorder is common in patients with diabetes.The cardinal symptoms include bloating,early satiety,epigastric discomfort,nausea,vomiting and delayed gastric emptying.Delayed gastric emptying affects pharmacokinetics of hypoglycemic agents,causes mismatch of peak postprandial blood glucose level and peak concentration of insulin and oral hypoglycemic agents,thereby affects glycemic control.There are different patterns of gastric motility disorder in different stages of diabetes.The most commonly used diagnostic method for gastric emptying is scintigraphic measurement.Treatment of gastric motility disorder in diabetes includes dietary modifications and prokinetic agents to ameliorate symptoms and improve glycemic control.Therapeutic approaches of gastroparesis include gastric electrical stimulation,endoscopic pyloric injection of botulinum toxin A,endoscopic placement of nasal-jejunum nutrient feeding tube and percutaneous endoscopic gastrostomy/jejunostomy and surgical therapy.