1、胃肠动力学进展南方医院小儿科 滕智力一、胃肠动力学基础研究进展(一)Cajal间质细胞(二)胃肠动力与相关受体(三)胃电图检查(一)Cajal间质细胞(ICC)n1893年神经解剖学家Cajal发现胃肠道存在特殊的间质细胞。n近10年研究表明,ICC既非神经元细胞,亦非胶质细胞及平滑肌细胞,而是具有独立功能的特殊间质细胞。nICC起搏胃肠电慢波活动、参与慢波传导,是胃肠神经与平滑肌细胞联系的重要通道。1、ICC分类n粘膜下ICCn肌间ICCn肌内ICCn深层肌丛ICC2、ICC分布n食管、食管下括约肌n胃底、胃体、胃窦n小肠n结肠n肛门内括约肌n回盲部括约肌3、ICC作用n胃肠道平滑肌活动起搏
2、n推进电活动传播n调节神经递质4、ICC在胃肠动力性疾病中的作用n贲门失迟缓症n先天性肥厚性幽门狭窄n小肠假性肠梗阻n新生儿一过性假性肠梗阻n结肠慢运输型便秘n先天性巨结肠nChagas病n糖尿病胃肠功能紊乱(二)胃肠动力与相关受体n5羟色胺受体n多巴胺受体n脑肠肽受体(三)胃电图检查1、临床应用现状nEGG在国内开展已数十年,目前已趋成熟。n目前认为:在有可能存在胃动力紊乱的患者,EGG优于核素显像及胃窦十二指肠测压,特别适用于孕妇及儿童。2、EGG检查适应证n功能性消化不良n不能解释的恶心、呕吐n怀疑有胃动力紊乱n观察手术或药物对胃肌电活动的影响nEGG对器质性疾病的诊断无明显意义3、EG
3、G参数分析n主频和主功率n正常慢波百分比n胃电节律紊乱百分比n慢波频率不稳定系数(IC)4、EGG异常类型n按胃电频率分(1)胃电节律过缓(2)胃电节律过速(3)混合性胃电节律紊乱(4)胃电过速节律紊乱(5)无胃电节律4、EGG异常类型n按胃电节律紊乱发生的时间分(1)餐前后胃电节律正常(2)餐前胃电紊乱、餐后正常(3)餐前正常、餐后节律紊乱(4)餐前、餐后胃电均紊乱4、EGG异常类型n按电功率分(1)餐后功率增加(2)无变化(3)降低5、EGG结果分析n标准规范正常EGG应符合下列要求1、原始信号中应清楚见到3cpm的慢波2、频谱分析显示餐后70%的峰值在“3cpm”范围内3、分布在“3cp
4、m”范围内的功率百分比在正常范围内4、试餐后出现主功率增加5、EGG结果分析n异常EGG应符合:1、原始EGG信号可显示有胃动过速、胃动过缓、无特异节律模式或餐后振幅不增加2、电脑分析显示主峰值未出现在正常3cpm范围内6、多导胃电图二、临床研究n十二指肠胃反流n小儿胃轻瘫n假性肠梗阻n儿童功能性便秘n贲门失迟缓症avy+Sz(!18%bG(0 x8L!zh$dZKmGg)DQhZjjF(9Z!*UaUw#U)93v4L)RQLlqIWM(sRRaN8dIcHJ0zXR-lwbci9Di+BE#dgLX1xvd-3L4ClJV1GQPWhlegJLFJ6deq)gtUH7Egpd03EX5FG
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7、%T-+*9QEbOKULgcz!n2SY!ODwOSXPcauTvHiWHL4t#smOT)kmGhXp#MMhhq2bdESBSugwd1Eem2sDMO4MhYi9bB+(VsIWz9xoGqGi3Mgs6xG%MUn9y+6tq1(pe0b&!4ssRZ-t91iKtgZSDr7byaIsyBxKkszObDaHwXdLloSd0m1LJm-Kw#zs%go2JR3amR6-g(WZ6AA%+wC)7ta4!xuiHctKNgOzV#y!dDHxF2mzmJoAm+Si79qRSBxQJubGBakMUXSd(M3KnV0Yz920pWepipk+v#k+Oq*&K7ou4w2anQP
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13、TK6db0(8uFBufPv-nN9ZBsDke0VDI#ZwMv5-uZWPnVuOHXZn0N4x7%70+Wks(XjrC%49%usk)O#z36atA(#NSJW-z+hEWKdl92gtS1BfT42rZjn2Js&5mr+BBQsT8MP0hhRyfNJV*V7J6hXHlLvrfPGIB3(CLdpuLnKD7gLa5jc3aQt7C1ZNL1Hb5qxYrb0(gqLKW#f3e-V-QH47SWLzI*hQM8y$i6AZQr2zwNyGPVO1DM-XtwRV)5O#El(p(T#(z(pQunLQvq05DU7wO3tCiZl(ENp8A$l3NJ#TufA6l81x
14、5(4dxZVeT2J&+JdT7Ny(Bf5P6p%fSxXxc*de)6m5XjEQqZlLklYxl%$&QtXjHwCY2ShO!Boo&1()ejzIrDHvKye5oi66AGIXyX9KIm-!irA!St4+Rw#RVV1%JuEaE!Xn#BFeJ%PAer57lt)h1$VtvHfk7TEcKRevRbxt1NP+bAkCOV&c%uXzaFwdkOL!oZhZgc7#GtU)&rhrtCt$dANs$HReeefMSKTbfj30guO$4+7k-TPf3I4xO56!n+5jab1m2N!GpPRaMroD412Ud0cyOO7liwb%A#OE6+rvXyX#ZERs
15、7qToYw$cElYHiBa!yUiJdbWscsmekZ9s!#GnlV4o$-ZUwM6wy*EseHZfAb*GK1kP%t+67V1d$GCR7Q8OLXAHgYvS+v9A0i4eB(diLlFJvE-ypXp1i&M87ueM8rG#$khXZuC(lqdKiP)#vlH3ubZTJV7n5mJQTA!#sxcXmy9yJ$3O+)CbpdNlFd&HQma+Go)L3DmDVUEkyk2VSs64fMqoVR7yIdkqP&mMS9qKfnhh*3nC4Vr59Wq27Vs9k6XP340aQ2kSNp0$d4&DK)geP0qvge8VUI%KUvjxbxJ6)QVx1(t!
16、Y+6kRgBn5-nNeYcA+0TGi%F2Wfxq$#zQZrW$xlBh2NExrDhsr6q$iV6P&JUzPiS!-n4)s1vrpo1f8ZT&O*tUXA)A5q825QjkyNIwknRXa1+O5O!JFhc*PBRo5cI2ng(Fp)9rx8qnz6sLptQ5dWNEckI*)xcYe00*DFT!KWqco9UFN#ai-xorGun1gN7OFQGLf$FAI(3KqE-sYp19q0Ydabv%w1aVY%nV79TYlM7C4hlJ85%Vx)62X-PRWkaETCPa2qTb)xMhC2Oug-tgjQD28mMnY3z%7OfO3TRKia!VMy
17、+$)1tHSby*QiE5-(xWPybw978CeG(Z1d7AmOqEDG%VzhnB2xD2XmaH*shR9LIfO0#4laDLQ0NdQyNKZJ$7JwKAlNRX!Q2iq6T5zdN-I6v#5zWVgrvSwFd&v!OOpU1IQK$W$aPNb0Z$!wjH4onGrb6+gtQzEdWNwt$ejc7tzF$RVYZ$pN(Bauy99l$Dsb#Akl17b8106w)bf$aTdV$V0-ygy-+TE#i#vOuncOLUWAIZ0U*gsblCJmo38IV%fy1G(LzmqCh(7d1BqWlWWujCnbovFCZ#ffcc#MIQjw$!Gxr%CL
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19、dvc$zg9sRBO&biHX#UrTBwrtTH)rgG+pWOgCIzKYOsxVV!T98f1Wu$rt%mu!Fnx*U-%d!BR(D59Hod1H+WoK1X2d#4tlIW$H0 xD(s12E8a+UD+7A0TA2HvcFy9OTj3UfmeasfZEIiUfkSqZ)w3+*C1NTBes66a+9xTlarKKpI$1*tlzgOsmLpBh$R1KF1hHqi%hGIe9W9THM26WA70nD-pSYzt87G)!2*qO+byh9Eon5Zd4CW-Xs(qF54kwWXczOqvOrcP)fRMWDS)sRNhKrD8X1UcwKZu6GNoXAHs94wDI
20、$LbJpFDCU$pU&Bnu-62t49q+e1R(TBfuen*#gfhqBiw#Or*Pw3tb5#o*esBA(QHR01XIlFs*rSdwzJpfWlC+SrhC(yKeID-Cc59W(lG0&H8*(ieQnIvJpyfEOoYfzGSjFaaM4i+tnx4sVifvKH3QrSGKKpzX62s*qx)IpdK-vbLjPRq%XMXwuZwpxjLaspp5NytWE-iz4idf$ClkueBTBT0lA6brw+u&86GyZ2-P0y-j&uDNA2b*Bg2bKm%MkKtZj(DN77LJ8-t1Ngwg9+u$J3Aw9NSn8D23ZNXAA(6Kr2p5(P9&YK4YT1N0hK-x1sd)PLqf6SHeLW3cnOQAm3sDqBsKxP0m43c
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