结肠透析对慢性肾脏病患者胃肠动力的影响

Effect of transcolonic therapy on gastrointestinal motility in patients with CKD

目的探讨结肠透析治疗对慢性肾脏病(chronic kidney disease,CKD)患者胃肠动力的影响。方法选取海洋石油总医院2014年10月至2016年5月门诊及病房诊断为CKD3b期~4期的患者92例,按照随机数字表法随机分成A组、B组,每组各46例。A组患者给予常规治疗+结肠途径治疗,结肠途径治疗模式为肠道灌洗-结肠透析-中药保留模式,每日1次,10次为一疗程。B组患者给予常规治疗。45例健康体检者组成对照组。应用胃肠道症状自评量表计算胃肠道症状评分(GI评分),应用氢呼气试验(hydrogen breath test,HBT)测量口-结肠转运时间(oral colon transit time,OCTT)。比较治疗、对照组消化道症状评分(GI评分)、OCTT等指标,同时比较A、B组治疗前、后GI评分、OCTT及部分生化指标包括血清肌酐(SCr)、尿素氮(BUN)、尿酸(uric acid,UA)、钾(K)、钠(Na)、氯(Cl)等。结果与对照组相比,治疗组GI评分明显升高,HBT试验测量OCTT时间提示转运延迟(31.52%)与转运过速(13.04%)的检出率明显升高(P<0.05)。与B组比较,A组患者治疗后GI评分明显下降,血清SCr、BUN、UA、K水平下降,OCTT时间明显缩短(P<0.05),而血清Na、Cl等指标未见明显变化(P>0.05)。结论 CKD中晚期患者普遍存在胃肠功能紊乱,表现为GI评分增高,以胃排空延迟为主要表现的胃肠动力障碍,结肠途径治疗可以显著减轻患者胃肠道症状、缩短OCTT,从而改善此类患者的胃肠动力障碍。

Objective To investigate the influence of transcolonic therapy on gastrointestinal motility in patients with CKD. Methods Forty-five health check-up individuals were selected（ control group）.Ninety-two patients with CKD of stage 3 b to 4（ treatment group） were randomly divided into two groups：group A given conventional therapy and transcolonic therapy once a day; group B given conventional therapy only. Gastrointestinal scores（ GIS）,which were evaluated by a gastrointestinal self-rating scale,as well as oral-colon transit time（ OCTT） measured by hydrogen breath tests were compared between control group and treatment group. The indexes above were compared before and after treatmentg between group A and group B. Results Compared to control group,the GIS were significantly increased in treatment group. Accordingly OCTT measured by HBT was obviously longer in treatment group. After treatment,GIS and the level of SCr,BUN,UA,K in group A were significantly lower than in group B. OCTT in group A was distinctly shorter in group B. Nevertheless the levels of Na and Cl had no significant difference in the two groups. Conclusions The patients with CKD show obviously gastric dysmotility. Transcolonic therapy is an efficient method to improve GIS and bradygastria in patients with CKD.