University of Kansas Medical Center, Kansas City, KS, USA.
Neurogastroenterol Motil. 2011 Oct;23(10):912-e396. doi: 10.1111/j.1365-2982.2011.01754.x. Epub 2011 Aug 1.
Our primary goals were to investigate the effects of two-channel gastric pacing on gastric myoelectrical activity, and energy consumption with the secondary intent to monitor gastric emptying and symptoms in patients with severe diabetic gastroparesis.
Four pairs of temporary pacing wires were inserted on the serosa of the stomach at the time of laparotomy to place the Enterra™ System in 19 patients with severe gastroparesis not responding to standard medical therapies. Two of the pairs were for electrical stimulation and the other two for recording. Five days after surgery the optimal pacing parameters for the entrainment of gastric slow waves in each patient were identified by serosal recordings. Two-channel gastric pacing was then initiated for 6 weeks using a newly developed external multi-channel pulse generator. Electrogastrogram (EGG), Total Symptom Score (TSS), and a 4-h gastric emptying test were assessed at baseline and after 6 weeks of active gastric pacing. Enterra™ device was turned OFF during the duration of this study.
Two-channel gastric pacing at 1.1 times the intrinsic frequency entrained gastric slow waves and normalized gastric dysrhythmia. After 6 weeks of gastric pacing, tachygastria was decreased from 15 ± 3 to 5 ± 1% in the fasting state and from 10 ± 2 to 5 ± 1% postprandially (P < 0.05), mean TSS was reduced from 21.3 ± 1.1 to 7.0 ± 1.5 (P < 0.05) and mean 4-h gastric retention improved from 42 to 28% (P = 0.05).
CONCLUSIONS & INFERENCES: Two-channel gastric pacing is a novel treatment approach which is able to normalize and enhance gastric slow wave activity as well as accelerate gastric emptying in patients with diabetic gastroparesis with a goal safety profile.
我们的主要目标是研究双道胃起搏对胃电活动和能量消耗的影响，并通过次要目的监测胃排空和患有严重糖尿病胃轻瘫患者的症状。
在剖腹手术时将四对临时起搏线插入胃的浆膜，以便在 19 名对标准药物治疗无反应的严重胃轻瘫患者中放置 Enterra™系统。两对用于电刺激，另外两对用于记录。手术后 5 天，通过浆膜记录确定每位患者胃慢波牵引入的最佳起搏参数。然后，使用新开发的外部多通道脉冲发生器开始进行为期 6 周的双道胃起搏。在基线和主动胃起搏 6 周后评估胃电图（EGG）、总症状评分（TSS）和 4 小时胃排空测试。在这项研究期间，关闭 Enterra™设备。
以固有频率的 1.1 倍双道胃起搏使胃慢波牵引入并使胃节律失常正常化。在胃起搏 6 周后，空腹时的快胃率从 15±3%降至 5±1%，餐后从 10±2%降至 5±1%（P<0.05），平均 TSS 从 21.3±1.1 降至 7.0±1.5（P<0.05），平均 4 小时胃潴留从 42%改善至 28%（P=0.05）。
双道胃起搏是一种新型治疗方法，能够使糖尿病胃轻瘫患者的胃慢波活动正常化和增强，并加速胃排空，具有良好的安全性。
