【作者】 张侃；

【导师】 侯晓华；

【作者基本信息】 华中科技大学 ， 内科学， 2007， 硕士

【摘要】 第一部分正向低频长脉冲对逆向高频长脉冲模拟胃异位起搏点诱发胃电过速的治疗作用目的:探讨正向长脉冲胃电刺激(forward gastric electrical stimulation, FGES)对逆向胃电刺激(retrograde gastric electrical stimulation, RGES)模拟胃异位起搏点诱发胃电过速的治疗作用。方法:7条纯种雌性比格犬,每一条均于胃大弯前壁浆膜层植入4对心脏起搏电极。通过距离口端最远的一对电极输入高频长脉冲RGES模拟异位起博,诱导胃电过速,刺激参数为0.3mA, 300ms, 9cpm。刺激10min后,在RGES造成胃电过速的同时,通过距离口端最近的一对电极输入不同振幅的低频长脉冲FGES来纠正胃电过速,从而获得正向控制胃电过速的最小能量。观察电刺激前、刺激中和刺激后消化不良症状并进行评分。结果:1.低频长脉冲FGES能够完全控制逆向高频长脉冲模拟异位起搏点诱发的胃电过速,所需最小振幅为5.0±0.93毫安,最小能量为1500±277.75 (毫秒*毫安),能够使胃正常慢波百分率完全恢复正常(95.61%±3.78% vs 42.68%±19.74%,p=0.001),胃电过速百分率下降(3.58%±0.85% vs 40.29%±19.68%,p=0.001) ,主频降低(6.35±0.66 vs 5.60±0.85, p=0.031),主功升高(-9.67±5.08 vs -2.26±1.03,p=0.001)。2.胃慢波基线期、RGES期间、FGES+RGES期间的消化不良症状评分均为1分,无明显差异。结论:正向低频长脉冲能够完全纠正由高频逆向长脉冲模拟人工异位起搏点引发的胃电过速,并恢复由此降低的胃动力。第二部分腹泻型和便秘型IBS患者近端胃舒张及排空功能的研究背景:实时B超测量近端胃舒张和排空功能在胃肠动力障碍性疾病中的应用已经越来越受到临床工作者的关注。目的:探讨腹泻型(D-IBS)和便秘型(C-IBS)肠易激综合征患者近端胃舒张功能和排空功能的改变。方法:健康志愿者、D-IBS、C-IBS患者各20名,实时B超测定饮用标准液体餐(500ml,170kcal)后不同时间段的近端胃容积的变化。结果:1. D-IBS组除试餐后5、60分钟,C-IBS组除试餐后60分钟外,近端胃容积均较健康对照组减小(P<0.05),D-IBS与C-IBS组0分钟近端胃容积和最大近端胃容积均显著小于健康对照组(156.19±23.20 vs 157.93±33.12 vs 183.02±26.46; 179.03±26.43 vs 174.08±34.18 vs 209.95±24.12, P<0.05) ;D-IBS与C-IBS比较,所有时间点近端胃容积无明显差异。2. D-IBS与C-IBS组胃延迟排空相与对照组相比无显著差别(4.75±4.43 vs 5.75±3.35 vs 6.25±2.75, P>0.05)。3. D-IBS组近端胃液体半排空时间(t1/2)较对照组显著提前(19.4±8.9 vs 28.5±4.8, P=0.039),C-IBS组t1/2与对照组相比也接近统计学意义(25.3±8.5 vs 28.5±4.8, P=0.063)。结论:IBS患者近端胃舒张功能受损,但两型间无差异,IBS组近端胃排空较对照组加快。更多还原

【Abstract】 Part 1 Forward long pulse-low frequency gastric electric stimulation normalize artificial ectopic tachygastria induced by retrograde long pulse-high frequency gastric electrical stimulationAims: Explore the minimum energy of forward long pulse-low frequency gastric electric stimulation (GES) to normalize tachygastria induced by artificially ectopicpacemaker using retrograde long pulses GES in high frequency.Methods: Seven female beagles dogs chronically implanted with four pairs of cardiac pacing electrodes along the greater curvature of stomach into serosa were applied with retrograde gastric electrical simulation (RGES) and forward gastric electrical stimulation (FGES). RGES performed via electrodes positioned in the distal part of antrum near pylorus, which included a series of fixed stimulating parameters: 9cpm, 300ms, 0.3mA, was kept on applying to produce substantial tachygastria. In contrast to RGES, FGES was performed with long pulses via the electrodes around the region of corpus, and its initially stimulating parameters was 5.5cpm, 300ms, 1mA, whose amplitude would be increased stepwise by 1mA until tachygastria induced by RGES was completely normalized. During the whole period of modulation and application of long pulses FGES, long-pulse RGES was simultaneously conducted without any discontinuance . Gastric slow waves and animaldyspeptic symptoms were recorded.Results: 1.the minimum amplitude, (5.0±0.93)mA and the minimum energy, (1500±277.75)mA*ms of FGES could completely normalize artificial ectopic tachygastria induced by RGES,which make the slow wave percentage recover to normal (95.61%±3.78% vs 42.68%±19.74%,p=0.001), the tackygastria percentage decrease(3.58%±0.85% vs 40.29%±19.68%,p=0.001), DF decrease (6.35±0.66 vs 5.60±0.85, p=0.031) and DP increase (-9.67±5.08 vs -2.26±1.03,p=0.001) 2.The score of dyspeptic symptoms either before or during RGES and FGES were 1 pointConclusions: Forward long pulses GES can normalize the artificial ectopic tachygastria induced by antral electrical stimulation as well as enhance the RGES-induced gastric hypomotility.PartⅡAccommodation and Emptying of Proximal Stomach to a Nutrition Meal in Cases of Irritable Bowel Syndrome with Diarrhea or ConstipationBackground: the application of real-time ulatrosound to investigate the accommodation and emytying of proximal stomach in the gastrointestinal disorders is receiving more attentions among the cliniciansAims: To investigate gastric accommodation and emptying in cases of irritable bowel syndrome (IBS) with diarrhea or constipation. Method: D-IBS, C-IBS, healthy controls, 20 cases respectively, were included. All were scanned fasting in a sitting position after drinking 500 ml Nutrition meal. Images were recorded up to 60 min postprandial after a 4-min ingestion of test meal using an ultrasound sector scanner.Result:(1) After the test meal, the D-IBS patients except 5, 60 min, and the C-IBS patients except 60 min all exhibited smaller volume of proximal stomach compared with healthy controls (P<0.05); During the test, both the volume of proximal stomach at 0 min and maximum volume of proximal stomach in IBS patients were smaller than those of healthy controls(156.19±23.20 vs 157.93±33.12 vs 183.02±26.46; 179.03±26.43 vs 174.08±34.18 vs 209.95±24.12, P<0.05). At the all eight time points, the volumes of the proximal stomach were not shown significant difference between the D-IBS patients and the C-IBS patients.(2) There was no significant difference in the lag phase of proximal stomach between IBS patients and healthy controls(4.75±4.43 vs 5.75±3.35 vs 6.25±2.75, P>0.05).(3) By comparison with healthy controls, the half time of the proximal gastric emptying in D-IBS patients was advanced (19.4±8.9 vs 28.5±4.8, P=0.039. which is near to statistical significance in C-IBS patients,Conclusion: The patients suffering D-IBS or C-IBS have impaired accommodation of the proximal stomach to a meal. Compared with that of the controls, there are no difference between two types. The emptying of proximal stomach in IBS patients was advanced.更多还原