Nguyen Nam-Q, Fraser Robert-J, Chapman Marianne, Bryant Laura-K, Holloway Richard-H, Vozzo Rosalie, Feinle-Bisset Christine
Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, South Australia.
World J Gastroenterol. 2006 Jul 21;12(27):4383-8. doi: 10.3748/wjg.v12.i27.4383.
To determine the response of the proximal stomach to small intestinal nutrients in critically ill patients.
Proximal gastric motility was measured in 13 critically ill patients (49.3 +/- 4.7 years) and 12 healthy volunteers (27.7 +/- 2.9 years) using a barostat technique. Recordings were performed at baseline, during a 60-min intra-duodenal infusion of Ensure (2 kcal/min), and for 2 h following the infusion. Minimum distending pressure (MDP), intra-bag volume and fundic wave activity were determined.
The MDP was higher in patients (11.7 +/- 1.1 vs 7.8 +/- 0.7 mmHg; P < 0.01). Baseline intra-bag volumes were similar in the 2 groups. In healthy subjects, a 'bimodal' proximal gastric volume response was observed. In patients, the initial increase in proximal gastric volume was small and delayed, but eventually reached a maximal volume similar to that of healthy subjects. In healthy subjects, the proximal gastric volume rapidly returned to baseline level after nutrient infusion (median 18 min). In contrast, the recovery of volume to baseline was delayed in critically ill patients (median 106 min). In 6 patients, the volume had not returned to baseline level 2 hours after nutrient infusion. In patients, fundic volume waves were less frequent (P < 0.05) and had lower amplitude (P < 0.001), compared to healthy subjects.
In critical illness, proximal gastric motor responses to small intestinal nutrient stimulation are abnormal.
确定危重症患者近端胃对小肠营养物质的反应。
采用恒压器技术对13例危重症患者（49.3±4.7岁）和12名健康志愿者（27.7±2.9岁）的近端胃动力进行测量。在基线期、十二指肠内输注安素（2千卡/分钟）60分钟期间以及输注后2小时进行记录。测定最小扩张压力（MDP）、袋内体积和胃底波活动。
患者的MDP较高（11.7±1.1对7.8±0.7 mmHg；P<0.01）。两组的基线袋内体积相似。在健康受试者中，观察到近端胃体积的“双峰”反应。在患者中，近端胃体积的初始增加较小且延迟，但最终达到与健康受试者相似的最大体积。在健康受试者中，营养物质输注后近端胃体积迅速恢复到基线水平（中位数18分钟）。相比之下，危重症患者的体积恢复到基线延迟（中位数106分钟）。在6例患者中，营养物质输注后2小时体积未恢复到基线水平。与健康受试者相比，患者的胃底体积波频率较低（P<0.05）且振幅较小（P<0.001）。
在危重症中，近端胃对小肠营养刺激的运动反应异常。
