功能性消化不良的膽囊排空功能及西沙必利的應(yīng)用研究

1、功能性消化不良的膽囊排空功能及西沙必利的應(yīng)用研究2022-04-03 Gallbladder empty ing in patie nts with functional dyspepsia:improveme ntof gallbladder motility with cisapride樊艷華竇艷玲戴希真董恩鈺張嵐Fan Yan hua, Dou Yan li ng, Dai Xizhe n, et al【摘要】目的 研究功能性消化不良FD的膽囊排空功能以及西沙必利在此中的作用。方法對(duì)91例FD患者與30名健康對(duì)照者于空腹和試餐后B超檢查測(cè)算膽囊容積、胃面積和膽囊排空率GBEF。結(jié)果 約1

2、/3 FD患者存在膽囊排空功能低下，F(xiàn)D組GBEF明顯低于正常組，且其速度慢，其中 GBEFma分別為 64.8%土 18.2%與 77.7%土 16.1%,P< 0.001 °FD組 30例33.0% 文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)膽囊排空功能低下者經(jīng)西沙必利治療后膽囊排空功能改善，GBEFma由 49.2%± 19.4%增為63.3%± 12.4%, P< 0.01 o治療后患者病癥明顯減輕。結(jié)論 研究說明約1/3的FD患者膽囊排空功能低下，西沙必利可改善此類患者的病癥及膽囊功能?！娟P(guān)鍵詞】消化不良膽囊排空西沙必利Gallbladder empty

3、 ing in patie nts with functional dyspepsia:文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)improveme nt of gallbladder motility with cisapride Fan Yan hua,個(gè)人學(xué)習(xí)文檔收集自網(wǎng)絡(luò)，僅用于Dou Yan li ng, Dai Xizhe n, et al. Departme nt of Gastroe nterology, 個(gè)人學(xué)習(xí)文檔收集自網(wǎng)絡(luò)，僅用于China-Japan Friendship Hospital, Beijing 100029【Abstract 】Objective To study g

4、allbladderemptying in patients with functional文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)dyspepsia (FD) and to know whether cisapride can improve the empty ing. Methods文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)Gastric and gallbladder emptying were evaluated by meansof real-timeultrasonography文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)(RUS) in 91 FD patie nts and in 30 no rmal subj

5、ects. Serial RUS sca ns were made at文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)fast and every 20 (first hour) or 30 (sec ond hour) minu tes after a liquid meal for2 hours.文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)Cisapride was given to treat the patientswith hypokineticgallbladderemptying for1 to 文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)2 weeks. Results (1)Gallbladder ejectionfr

6、action (GBEF) in FD patients was much 文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)lower and slower than that in normal subjects. The GBEFmax was 64.8%± 18.2% in the文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)FD group and 77.7% ± 16.1% in the normal group (P?.001). Thirty patients (33.0%)文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)were con sidered to have hypok in etic gallbl

7、adder empty ing as GBEF60' and GBEFmax文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)in these patie nts were 2s above the no rmal group. (2) 25 patie nts were found withdelayed 文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)gastricemptying and 11 of them (44.0%) also with hypokineticgallbladder emptying.The文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)GBEFmax in patie nts with delayed gas

8、tric empty ing was slightly lower tha n those without,文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)but there was no statistical differe nee betwee n the two groups. (3) Gallbladderemptyi ng 文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)was improved in patients with hypokinetic gallbladderemptying treated with cisapride.文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)GBEFmax in creased from 4

9、9.2%± 19.4% to 63.3% ± 12.4% (P?.01). After treatme nt,文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)the symptoms of the patientsrelieved. There was no statisticalcorrelationbetweenthe文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)improveme nt of gallbladder and gastric empty ing. Con clusi on About one third of thepatie nts文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)with functio

10、nal dyspepsia have hypokinetic gallbladder emptying, and cisapride seems to be 文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)useful in improvi ng the empty ing.【Key words】Dyspepsia Gallbladder emptying Cisapride文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)功能性消化不良(FD)病人常見，幾乎占消化科門診病人的半數(shù)。FD病因尚不清，上胃腸動(dòng)力障礙、特別是胃排空延遲在發(fā)病中所起的重要作用已較公認(rèn)。國內(nèi)外有關(guān)其膽囊排空功 能的研究均較少，且結(jié)果不一致，局部結(jié)果顯示其膽

11、囊排空功能低下】1,或速度減慢】2。消化道促動(dòng)力劑西沙必利對(duì)FD病人胃排空有促進(jìn)作用，其能否促進(jìn)膽囊排空功能，目前國內(nèi)尚未見報(bào)道。我們自 1995年5月至1996年5月采用實(shí)時(shí)超聲對(duì)照研究了91例FD患者的 膽囊及胃排空功能，并觀察了西沙必利對(duì)膽囊排空功能的作用。對(duì)象和方法一、研究對(duì)象91例FD患者中男36例，女55例，年齡2065歲，平均43.3歲，均經(jīng)化驗(yàn)、B超、胃 鏡等檢查排除了消化道器質(zhì)性疾病，無糖尿病等影響消化功能的全身性疾病，亦無腹部手術(shù) 史，符合FD的診斷標(biāo)準(zhǔn)。FD組與30名健康對(duì)照者在年齡、身高、體重等方面無統(tǒng)計(jì)學(xué)差異。二、研究方法將FD組腹痛、腹脹、早飽等病癥根據(jù)其嚴(yán)重程度分

12、為03級(jí)，其中每1級(jí)積1分，并參考1991年荷蘭會(huì)議所定標(biāo)準(zhǔn)將FD分為4型。91例中運(yùn)動(dòng)障礙型 62例，潰瘍樣型17例，反流樣型4例，復(fù)合型8例。膽囊排空功能低下者不管其胃排空功能正常與否予西安楊森制藥有 限公司生產(chǎn)的西沙必利(商品名普瑞博思)510 mg，每日3次，治療12周后復(fù)查。三、膽囊、胃排空功能測(cè)定試餐為250 ml混合奶(250卡)，蛋白質(zhì)、脂肪與碳水化合物熱卡比為1 : 2.6 : 2。由我院營養(yǎng)部配制。膽囊測(cè)量取平臥位，于空腹及進(jìn)餐后每20分鐘(第1小時(shí))或30分鐘(第2小時(shí))分別測(cè)量。每次B超檢查前先確定膽囊最大縱軸圖象，測(cè)得膽囊長(zhǎng)徑L和前后徑H,然后轉(zhuǎn)動(dòng)探頭90度測(cè)得膽囊最大寬徑 W膽囊容積計(jì)算公式 GBV=LHW/6，膽囊排空率(GBEF)=(GBVf-GBVt)/GBVf， 文檔收集自網(wǎng)絡(luò)，僅用于個(gè)人學(xué)習(xí)其中GBVf GBVt分別為空腹和餐后某一時(shí)間的膽囊容積。胃的測(cè)量參照 Marzio法3,采用單切面法，于上腹以腹主動(dòng)脈或腸系膜上靜脈為參照縱形掃查，顯示出圓形或橢圓形胃的最大圖像，測(cè)得其前后徑A和上下徑B,胃面積計(jì)算公式GS=